# Interventions to Minimize Unnecessary Antibiotic Use for Acute Otitis Media: A Meta-Analysis

## TL;DR

Following national guidelines for treating ear infections in children could significantly reduce unnecessary antibiotic use.

## Contribution

This study quantifies the potential reduction in antibiotic use if guidelines for acute otitis media are followed.

## Key findings

- Adhering to American Academy of Pediatrics guidelines could reduce antibiotic days of therapy by 56%.
- Following NICE guidelines could reduce antibiotic days of therapy by 71%.
- Watchful waiting and short-course interventions are most effective in reducing overprescribing.

## Abstract

What are the main findings?
Prescribing data for the treatment of acute otitis media (AOM) were abstracted from 83 studies in this meta-analysis.If prescribers followed the American Academy of Pediatrics guidelines for prescribing, annual antibiotic days of therapy (DOT) could be reduced by 60.6 million days (56%), while following the National Institutes for Health and Care Excellence guidelines for prescribing could reduce DOT by 76.7 million days (71%).

Prescribing data for the treatment of acute otitis media (AOM) were abstracted from 83 studies in this meta-analysis.

If prescribers followed the American Academy of Pediatrics guidelines for prescribing, annual antibiotic days of therapy (DOT) could be reduced by 60.6 million days (56%), while following the National Institutes for Health and Care Excellence guidelines for prescribing could reduce DOT by 76.7 million days (71%).

What is the implication of the main finding?
Adherence to national guidelines for AOM management could avert millions of antibiotic DOT annually.Watchful waiting and short duration interventions have the greatest impact on antibiotic overprescribing.

Adherence to national guidelines for AOM management could avert millions of antibiotic DOT annually.

Watchful waiting and short duration interventions have the greatest impact on antibiotic overprescribing.

Backgrounds/Objectives: Acute otitis media (AOM) is the leading reason antibiotics are prescribed to children. Despite guidelines advocating for watchful waiting and shorter antibiotic durations, overprescribing remains a concern. This meta-analysis aims to quantify potential reduction in antibiotic days of therapy (DOT) for AOM if prescribers adhered to guidelines. Methods: Cochrane databases were sourced for studies on ear infections, diagnostic accuracy, antibiotic duration, and watchful waiting. Randomized clinical trials, observational studies, and quality improvement reports of children aged 6 months–17 years with uncomplicated AOM published between 2000 and 2024 from the U.S., Canada, and Europe. Of 4187 studies, 425 met selection criteria. PRISMA guidelines were adhered to for independent extraction by multiple reviewers. Pooled prevalence of AOM outcomes and odds ratios (OR) for effectiveness interventions were calculated using the DerSimonian-Laird random effects model. A simulation study compared current practice to national guidelines. Results: Eighty-six studies found an estimated 107 million DOT prescribed to children in the U.S. annually for AOM. Following the American Academy of Pediatrics’ guidelines could reduce DOT by 57.9 million days (54%). Adherence to NICE guidelines could reduce DOT by 74.1 million days (70%). Watchful waiting and short-course antibiotic interventions had pooled Ors of 4.35 and 7.12, respectively, for decreasing DOT. Conclusions: Adherence to guidelines for AOM management could avert millions of antibiotic DOT. Watchful waiting and short-duration interventions are most impactful on antibiotic overprescribing.