Sulfisoxazole Prophylaxis of Middle Ear Effusion and Recurrent Acute Otitis Media

A Systematic Review and Meta‐Analysis of the Efficacy of Antimicrobial Chemoprophylaxis for Recurrent Acute Otitis Media in Children

“…The literature search findings are summarised in Figure 1 . In total 20 studies ( n = 2210 children, median 81 participants per study [IQR 54–157, range 21–364]) were included in qualitative analysis, of which nine were suitable for quantitative meta‐analysis (Table 1 ) [ 22 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. Only two non‐controlled studies reported participants recruited in the post‐PCV era [ 47 , 63 ].…”

“…Only two non‐controlled studies reported participants recruited in the post‐PCV era [ 47 , 63 ]. The majority of studies used the Lieberthal et al [ 6 ] definition of rAOM as criteria for inclusion, defined as three or more well‐documented and separate AOM episodes in the preceding 6 months or four or more episodes in the preceding 12 months with at least one episode in the past 6 months [ 22 , 44 , 46 , 47 , 50 , 51 , 52 , 53 , 57 , 58 , 62 , 63 ]. The most common intervention in the treatment group was the use of amoxicillin chemoprophylaxis (10/20 studies) [ 22 , 44 , 46 , 47 , 53 , 57 , 58 , 60 , 61 , 63 ].…”

“…The most common intervention in the treatment group was the use of amoxicillin chemoprophylaxis (10/20 studies) [ 22 , 44 , 46 , 47 , 53 , 57 , 58 , 60 , 61 , 63 ]. The most frequent control intervention was placebo (12/20 studies) [ 22 , 49 , 50 , 52 , 54 , 55 , 57 , 58 , 59 , 60 , 61 , 62 ], followed by tympanostomy tube insertion (2/20 studies) [ 22 , 49 ]. The follow‐up period and duration of therapy was variable, median 6 (IQR 4–11.6, range 1–48) months, median 4 (IQR 3–6, range 1–48) months, respectively.…”

“…The follow‐up period and duration of therapy was variable, median 6 (IQR 4–11.6, range 1–48) months, median 4 (IQR 3–6, range 1–48) months, respectively. Compliance with treatment, often by measurement of medication volume, a medication diary or urine analysis, was quantified in 10 studies (50%) [ 22 , 50 , 53 , 54 , 55 , 57 , 58 , 59 , 61 , 62 ], of which the rates were generally high. Complications of the antimicrobial treatment was described in five studies (25%), of which the rates were low [ 22 , 48 , 50 , 59 , 61 ].…”

“…AOM episodes were reported in relation to possible risk factors such as age [ 22 , 44 , 47 , 48 , 52 , 53 , 55 , 57 , 62 , 63 ], cigarette smoke exposure at home [ 47 ], sex [ 22 , 47 , 48 , 52 , 53 , 57 , 63 ], season [ 22 , 53 , 57 , 58 ], attendance at day‐care [ 47 , 52 , 53 , 57 ] and history of atopy [ 52 ]. Sub‐group meta‐analysis (included any study defined definition of rAOM) was limited by study data, but was performed in groups with known risk factors including males; RR 0.32 (95% CI 0.04–2.65, I 2 62% p = 0.11, n = 69, two studies), and children 5 years or younger; RR 0.28 (95% CI 0.05–1.45, I 2 48% p = 0.17, n = 113, two studies) (Figure 5 ).…”