This is a new guideline from NICE on when to use antibiotics for otitis media (March 2018). It doesn’t change common practice, but I found some of the statistics really helpful for explaining why we prescribe in some groups and not others. There is an excellent patient leaflet explaining things too.
Some background info:
- Most have cleared within 3 days, but it can last up to a week.
- It can be viral or bacterial, or both can be present at the same time.
- Complications are rare (for example the NNT with antibiotics to avoid one case of mastoiditis is 4,831).
Antibiotic effect on symptoms of Otitis Media
Antibiotics make little difference to symptoms. The NNT for an improvement at 2-3d is 24. Put another way, at 2-3d, 88% of kids in the antibiotic group had no pain, whereas 84% in the no antibiotic group had no pain.
The NNH (number needed to harm) with antibiotics is 13 (vomiting, diarrhoea or rash). So if you use antibiotics in most patients, you will harm more than you will help.
