Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of short course (<4 days) of antibiotics for treatment of acute otitis media in children: A systematic review of randomized controlled trials

  • Research Paper
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To determine the efficacy of a short course of antibiotics (<4 days) in comparison to a longer course (≥4 days) for the treatment of acute otitis media in children.

Data sources

Electronic databases, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences.

Review Methods

Randomized controlled trials of the empiric treatment of acute otitis media comparing antibiotic regimens of <4 days versus ≥4 days in children between four weeks to eighteen years of age were included. The trials were grouped by pharmacokinetic behavior of short-course antibiotics into short-acting antibiotics, parenteral ceftriaxone, and long-acting azithromycin.

Results

We reviewed 35 trials, which provided 38 analytic components. Overall, there was no evidence of an increased risk of treatment failure until one month with a short-course of antibiotics (RR=1.06, 95% CI 0.95 to 1.17, P=0.298). Use of short-acting oral antibiotic in short-course was associated with a significantly increased risk of treatment failure (RR=2.27, 95% CI: 1.04 to 4.99). There was a slightly increased risk of treatment failure with parenteral ceftriaxone (RR=1.13, 95% CI 0.99 to 1.30). The risk of adverse effects was significantly lower with short-course regimens (RR=0.58, 95% CI: 0.48 to 0.70).

Conclusion

There is no evidence of an increased risk of treatment failure with short course of antibiotics for acute otitis media. Among the short-course regimens, azithromycin use was associated with a lower risk of treatment failure while short-acting oral antibiotics and parenteral ceftriaxone may be associated with a higher risk of treatment failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Freid VM, Mukuc DM, Rooks RN. Ambulatory health care visits by children: principal diagnosis and place of visit. Vital Health Stat 1998;13:1–23.

    Google Scholar 

  2. Rovers MM, Schilder AGM, Zielhuis GA, Rosenfeld RM. Otitis media. Lancet 2004;363:465–473.

    Article  PubMed  Google Scholar 

  3. Marcy M, Takata G, Chan LS, Shekelle P, Mason W, Wascman L, et al. Management of acute otitis media: evidence report/technology assessment no.15 (prepared by the Southern California Evidence-based Practice Center under contract no._290-97-0001). AHRQ Publication No. 01-E010. Rockville, MD: Agency for Healthcare Research and Quality, 2001.

    Google Scholar 

  4. Glasziou PP, Del Mar CB, Sanders SL, Hayem M. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2004;1:CD 000219.

    Google Scholar 

  5. Rosenfeld RM, Vertrees JE, Carr J, Cipolle RJ, Uden DL, Giebink GS, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr 1994;124:355–367.

    Article  PubMed  CAS  Google Scholar 

  6. Rovers MM, Glasizou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, et al. Antibiotics for acute otitis media: A meta-analysis with individual patient data. Lancet 2006;368:1429–1435.

    Article  PubMed  CAS  Google Scholar 

  7. Paradise JL. Short-course antimicrobial treatment for acute otitis media. Not best for infants and young children. JAMA 1997;278:1640–1642.

    Article  PubMed  CAS  Google Scholar 

  8. Pichichero ME, Cohen R. Shortened course of antibiotic therapy for acute otitis media, sinusitis and tonsillopharyngitis. Pediatr Infect Dis J 1997;16:680–695.

    Article  PubMed  CAS  Google Scholar 

  9. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE, Wincott JL, Sitar DS, Klassen TP, et al. Treatment of acute otitis media with a shortened course of antibiotics: A meta-analysis. JAMA 1998;279:1736–1742.

    Article  PubMed  CAS  Google Scholar 

  10. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SEA, Wincott JL, Sitar DS, Klassen TP, et al. Short course antibiotics for acute otitis media. Cochrane Database System Rev 2000;2:CD 001095.

    Google Scholar 

  11. World Health Organization. Pocketbook of hospital care for children: Guidelines for the Management of common illnesses with limited resources. Geneva: WHO; 2005. p. 162.

    Google Scholar 

  12. Pakistan Multicentre Amoxicillin Short Course Therapy (MASCOT) Pneumonia Study Group. Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double blind trial. Lancet 2002; 360: 835–841.

    Article  Google Scholar 

  13. Agarwal G, Awasthi S, Kabra SK, Kaul A, Singhi S, Walter SD; ISCAP Study Group. Three day versus five day treatment with amoxicillin for nonsevere pneumonia in young children: a multicentre randomised controlled trial. BMJ 2004;328:1066.

    Google Scholar 

  14. Marchant CD, Carlin SA, Johnson CE, Shurin PA. Measuring the comparative efficacy of antibacterial agents for acute otitis media: The Pollyanna phenomenon”. J Pediatr 1992;120:72–77.

    Article  PubMed  CAS  Google Scholar 

  15. Dagan R, McCracken GH. Flaws in design and conduct of clinical trials in acute otitis media. Pediatr Infect Dis J 2002;21:894–902.

    Article  PubMed  Google Scholar 

  16. Fox MP, Fox LM. Resolving design problems in equivalency trials. J Pediatr 2006;149:12–16.

    Article  PubMed  Google Scholar 

  17. Higgins JPT, Green S, eds. Assessment of study quality. Cochrane Handbook for Systematic Reviews of Interventions 4.2. 6 [updated September 2006]; Section 6. In: The Cochrane Library, Issue 4. Chichester: John Wiley & Sons; 2006.

  18. Higgins JPT, Deeks JJ, Altman DG. Chapter 16: Special topics in statistics. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated Februrary 2008). The Cochrane collaboration, 2008. Available from www.Cochranehandbook. org. Accessed on March 31, 2008.

  19. Sterne JAC, Egger M, Smith GD. Investigating and dealing with publication and other biases. In: Egger M, Smith GD, Altman DG, eds. Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ Books 2001.p. 189–208.

    Chapter  Google Scholar 

  20. Sterne JAC, Bradburn MJ, Egger M. Meta-analysis in STATA TM. In: Egger M, Smith GD, Altman DG. Systematic reviews in health care: Metaanalysis in context. London: BMJ Books; 2001. p. 347–369.

    Chapter  Google Scholar 

  21. Steichen TJ, Egger M, Sterne JAC. sbe19.1: Tests for publication bias in meta-analysis. Stata Technical Bulletin 1998;44:3–4.

    Google Scholar 

  22. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539–1558.

    Article  PubMed  Google Scholar 

  23. Harris RJ, Harbord RM, Sterne JAC. Stata Version 9 Update (Distribution Date February 19, 2007) for the Stata User Written Programme sbe24 (Bradburn MJ, Deeks JJ, Altman D. sbe24: metan — an alternative meta-analysis command. Stata Technical Bulletin 1999; 44: 4–15). http://fmwww.bc.edu/RePEc/bocode/m. Accessed on March 24, 2007.

  24. Tables. Human Development Report 2006, United Nations Development Programme. http://hdr.undp.org/hdr2006/pdfs/report/HDR_2006_Tables.pdf. Accessed on August 26, 2007.

  25. Harbord R, Steichen T, Sharp SJ. 2004. “metareg: update to Stata module to perform meta-analysis regression” (Sharp SJ. sbe23: Meta-analysis regression. Stata Technical Bulletin 1998; 42: 16–22). Statistical Software Components S 4446201, Boston College Department of Economics, revised 02 Feb 2005. http://ideas.repec.org/c/boc/bocode/s446201.html. Accessed March 15, 2007.

  26. Stickler GB, Sasano JR, Mcbean JB. Treatment of acute otitis media in children: Clinical trial. Clin Pediatr (Phila) 1963;2:534–540.

    CAS  Google Scholar 

  27. Stickler GB, Mcbean JB. The treatment of acute otitis media in children. II. A second clinical trial. JAMA 1964;187:85–89.

    PubMed  CAS  Google Scholar 

  28. Rubenstein MM, Mcbean JB, Hedgecock LD, Stickler GB. The treatment of acute otitis media in children. 3. A third clinical trial. Am J Dis Child 1965;109:308–313.

    PubMed  CAS  Google Scholar 

  29. Sederberg-Olsen J. Penicillin therapy for acute otitis media in children. How long should treatment continue? Ugeskr Laeger 1983;145:1201–1204.

    PubMed  Google Scholar 

  30. Baba S, Murai K, Kinoshita H, Kawai T, Koyama K, Tsukiyama M, et al. [Double-blind comparative trial of cefroxadine and cephalexin in the treatment of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media] Jpn J Antibiot 1983;36:2595–2634.

    PubMed  CAS  Google Scholar 

  31. Baba S, Mori Y, Suzuki K, Unno T, Kawabori S, Yanai T, et al. Evaluation of the efficacy of ceftriaxone in acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media. A comparative study with cefotiam as the control. Jpn J Antibiot 1989;42:212–247.

    PubMed  CAS  Google Scholar 

  32. Muller O. Comparison of azithromycin versus clarithromycin in the treatment of patients with upper respiratory tract infections. J Antimicrob Chemother 1993;31Suppl E:137–146.

    PubMed  Google Scholar 

  33. Doherty B. An open comparative study of azithromycin versus cefaclor in the treatment of patients with upper respiratory tract infections. J Antimicrob Chemother 1996;37(Suppl C):71–81.

    Google Scholar 

  34. Bain J, Murphy E, Ross F. Acute otitis media: Clinical course among children who received a short course of high dose antibiotic. BMJ (Clin Res Ed) 1985;91:1243–1246.

    Article  Google Scholar 

  35. Jones R, Bain J. Three-day and seven-day treatment in acute otitis media: A double-blind antibiotic trial. J R Coll Gen Pract 1986;36:356–358.

    PubMed  CAS  Google Scholar 

  36. Gehanno P, Taillebe M, Denis P, Jacquet P, Hoareau J, Gojon D, et al. Short-course cefotaxime compared with five-day co-amoxyclav in acute otitis media in children. J Antimicrob Chemother 1990;26(Suppl A):29–36.

    PubMed  Google Scholar 

  37. Chaput de Saintongue DM, Levine DF, Temple Savage I, Burgess GW, Sharp J, Mayhew SR, et al. Trial of three-day and ten-day courses of amoxicillin in otitis media. BMJ 1982;284:1078–1081.

    Article  Google Scholar 

  38. Meistrup-Larsen KI, Sorensen H, Johnsen NJ, Thomsen J, Mygind N, Sederberg-Olsen J. Two versus seven days penicillin treatment for acute otitis media. A placebo controlled trial in children. Acta Otolaryngol 1983;96:99–104.

    Article  PubMed  CAS  Google Scholar 

  39. Puczynski MS, Stankiewicz JA, O’Keefe JP. Single dose amoxicillin treatment of acute otitis media. Laryngoscope 1987;97:16–18.

    Article  PubMed  CAS  Google Scholar 

  40. Varsano I, Frydman M, Amir J, Alpert G. Single intramuscular dose of ceftriaxone as compared to 7-day amoxicillin therapy for acute otitis media in children. A double-blind clinical trial. Chemotherapy 1988;34(Suppl 1):39–46.

    Article  PubMed  Google Scholar 

  41. Pestalozza G, Cioce C, Facchini M. Azithromycin in upper respiratory tract infections clinical trial in children with otitis media. Scand J Infect Dis 1992;83:22–25.

    CAS  Google Scholar 

  42. Daniel RR. Comparison of azithromycin and coamoxiclav in the treatment of otitis media in children. J Antimicrob Chemother 1993;31(Suppl E):65–71.

    PubMed  Google Scholar 

  43. Green SM, Rothrock SG. Single-dose intramuscular ceftriaxone for acute otitis media in children. Pediatrics 1993;91:23–30.

    PubMed  CAS  Google Scholar 

  44. Mohs E, Rodriguez-Solares A, Rivas E, el Hoshy Z. A comparative study of azithromycin and amoxycillin in paediatric patients with acute otitis media. J Antimicrob Chemother 1993;31(Suppl E):73–79.

    PubMed  Google Scholar 

  45. Schaad UB. Multicentre evaluation of azithromycin in comparison with co-amoxiclav for the treatment of acute otitis media in children. J Antimicrob Chemother 1993;31(Suppl E):81–88.

    PubMed  Google Scholar 

  46. Chamberlain JM, Boenning DA, Waisman Y, Ochsenschlager DW, Klein BL. Single-dose ceftriaxone versus 10 days of cefaclor for otitis media. Clin Pediatr (Phila) 1994;33:642–646.

    Article  CAS  Google Scholar 

  47. Principi N. Multicentre comparative study of the efficacy and safety of azithromycin compared with amoxicillin/clavulanic acid in the treatment of paediatric patients with acute otitis media. Eur J Clin Microbiol Infect Dis 1995;14:669–676.

    Article  PubMed  CAS  Google Scholar 

  48. Arguedas A, Loaiza C, Herrera M, Mohs E. Comparative trial of 3-day azithromycin versus 10-day amoxycillin clavulanate potassium in the treatment of children with acute otitis media with effusion. Int J Antimicrob Agents 1996;6:233–238.

    Article  PubMed  CAS  Google Scholar 

  49. Bauchner H, Adams W, Barnett E, Klein J. Therapy for acute otitis media. Preference of parents for oral or parenteral antibiotic. Arch Pediatr Adolesc Med 1996;150:396–399.

    PubMed  CAS  Google Scholar 

  50. Rodriguez AF. An open study to compare azithromycin with cefaclor in the treatment of children with acute otitis media. J Antimicrob Chemother 1996;37(Suppl C):63–69.

    PubMed  CAS  Google Scholar 

  51. Arguedas A, Loaiza C, Rodriguez F, Herrera ML, Mohs E. Comparative trial of 3 days of azithromycin versus 10 days of clarithromycin in the treatment of children with acute otitis media with effusion. J Chemother 1997;9:44–50.

    PubMed  CAS  Google Scholar 

  52. Barnett ED, Teele DW, Klein JO, Cabral HJ, Kharasch SJ. Comparison of ceftriaxone and trimethoprim-sulfamethoxazole for acute otitis media. Greater Boston Otitis Media Study Group. Pediatrics 1997;99:23–28.

    Article  PubMed  CAS  Google Scholar 

  53. Celik O, Gok U, Yalcin S, Karlidag T, Susaman N, Cetinkaya T. Comparison of the clinical efficiacy of azithromycin and cerufoxime axetile in the treatment of patients with acute otitis media. Mikrobiyol Bul 1997;31:253–261.

    Google Scholar 

  54. Ficnar B, Huzjak N, Oreskovic K, Matrapazovski M, Klinar I. Azithromycin: 3-day versus 5-day course in the treatment of respiratory tract infections in children. Croatian Azithromycin Study Group. J Chemother 1997;9:38–43.

    PubMed  CAS  Google Scholar 

  55. Varsano I, Volovitz B, Horev Z, Robinson J, Laks Y, Rosenbaum I, et al. Intramuscular ceftriaxone compared with oral amoxicillin-clavulanate for treatment of acute otitis media in children. Eur J Pediatr 1997;156:858–863.

    Article  PubMed  CAS  Google Scholar 

  56. De J, De M, Aristegui J, Rodrigo C, Del C, Borque C, et al. International multicenter study comparing azithromycin and amoxicillin-clavulinemic acid in the treatment of pediatric acute otitis media. Acta Pediatr Esp 1998;56:350–355.

    Google Scholar 

  57. Garcia Callejo FJ, Velert Vila MM, Orts Alborch MH, Pardo Mateu L, Esparcia Navarro M. Comparison of azithromycin, amoxicillin/clavulanic acid and cefaclor in the treatment of acute ENT infections. Acta Otorrinolaringol Esp 1998;49:306–312.

    PubMed  CAS  Google Scholar 

  58. Kara CO, Ozuer MZ, Kilic I, Yalcin AN, Ergin H. Comparison of amoxicillin with second and third generation cephalosporins in the treatment of acute otitis media. Infezioni in Medicina 1998;6:93–95.

    PubMed  Google Scholar 

  59. Al Ghamdi YS, El Kafrawi M, Aglan YI, Saleh MA. Efficacy of single-dose intramuscular ceftriaxone for treatment of acute otitis media in children. Saudi Medical J 1999;20:41–45.

    Google Scholar 

  60. Cohen R, Navel M, Grunberg J, Boucherat M, Geslin P, Derriennic M, et al. One dose ceftriaxone vs. ten days of amoxicillin/clavulanate therapy for acute otitis media: Clinical efficacy and change in nasopharyngeal flora. Pediatr Infect Dis J 1999;18:403–409.

    Article  PubMed  CAS  Google Scholar 

  61. Dagan R, Leibovitz E, Fliss DM, Leiberman A, Jacobs MR, Craig W, et al. Bacteriologic efficacies of oral azithromycin and oral cefaclor in treatment of acute otitis media in infants and young children. Antimicrob Agents Chemother 2000;44:43–50.

    Article  PubMed  CAS  Google Scholar 

  62. Slapak I, Hornik P, Dezort J. Azithromycin and clarithromycin: Clinical and economic comparative study in the treatment of acute otitis media in children. Otorinolaryngol Foniatr 2000;49:105–109.

    Google Scholar 

  63. Kawalski H, Blacha E, Kopacz M, Mos M, Cierpiol-Tracz E, Welniak M, et al. Azithromycin vs. Clarithromycin and Co-amoxiclav: Clinical and economic comparison in the treatment of acute otitis media in children. New Med 2001;4:14–19.

    Google Scholar 

  64. Arrieta A, Arguedas A, Fernandez P, Block SL, Emperanza P, Vargas SL, et al. High-dose azithromycin versus high-dose amoxicillinclavulanate for treatment of children with recurrent or persistent acute otitis media. Antimicrob Agents Chemother 2003;47:3179–3186.

    Article  PubMed  CAS  Google Scholar 

  65. Block SL, Arrieta A, Seible M, McLinn S, Eppes S, Murphy MJ. Single dose (30mg/kg) azithromycin compared with 10-day amoxicillin/clavulanate (45mg/kg/day) for the treatment of uncomplicated acute otitis media. Curr Ther Res 2003;64(Suppl A):A 30–42.

    CAS  Google Scholar 

  66. Dunne MW, Latiolais T, Lewis B, Pistorius B, Bottenfield G, Moore WH, et al. Randomized, double-blind study of the clinical efficacy of 3 days of azithromycin compared with co-amoxiclav for the treatment of acute otitis media. J Antimicrob Chemother 2003;52:469–472.

    Article  PubMed  CAS  Google Scholar 

  67. Oguz F, Unuvar E, Suoglu Y, Erdamar B, Dundar G, Katircioglu S, et al. Etiology of acute otitis media in childhood and evaluation of two different protocols of antibiotic therapy: 10 days cefaclor vs. 3 days azitromycin. Int J Pediatr Otorhinolaryngol 2003; 67: 43–51.

    Article  PubMed  Google Scholar 

  68. Yamei Z, Dong P, Lu P. Efficacy and safety of one dose ceftriaxone vs. ten-day oral amoxicillin for treatment of acute otitis media in children. Zhonghua Er Ke Za Zhi 2003;41:135–138.

    Google Scholar 

  69. Wang CY, Lu CY, Hsieh YC, Lee CY, Huang LM. Intramuscular ceftriaxone in comparison with oral amoxicillin-clavulanate for the treatment of acute otitis media in infants and children. J Microbiol Immunol Infect 2004;37:57–62.

    PubMed  CAS  Google Scholar 

  70. Arguedas A, Emparanza P, Schwartz RH, Soley C, Guevara S, Caprariis de PJ, et al. A randomized, multicenter, double blind, double dummy trial of single dose azithromycin versus high dose amoxicillin for treatment of uncomplicated acute otitis media. Pediatr Infect Dis J 2005;24:153–161.

    Article  PubMed  Google Scholar 

  71. Guven M, Bulut Y, Sezer T, Aladag I, Eyibilen A, Etikan I. Bacterial etiology of acute otitis media and clinical efficacy of amoxicillin-clavulanate versus azithromycin. Int J Pediatr Otorhinolaryngol 2006;70:915–923.

    Article  PubMed  Google Scholar 

  72. American Academy of Pediatrics and American Academy of Family Physicians, Clinical Practice Guidelines. Subcommittee on Management of Acute Otitis Media: Diagnosis and Management of Acute Otitis Media. Pediatrics 2004; 113: 1451–1465.

    Article  Google Scholar 

  73. Chow AW, Hall CB, Klein JO, Kammer RB, Meyer RD, Remington JS. Evaluation of new anti-infective drugs for the treatment of respiratory tract infections. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis 1992;15(Suppl 1):S62–88.

    PubMed  Google Scholar 

  74. Howie VM, Ploussard JH. The “In Vitro Sensitivity Test”-bacteriology of middle ear exudates. Pediatrics 1969;44:940–944.

    PubMed  CAS  Google Scholar 

  75. Canafax DM, Giebink GS. Clinical and pharmacokinetic basis for antimicrobial treatment of acute otitis media. Otolaryngol Clin North Am 1991;24:859–874.

    PubMed  CAS  Google Scholar 

  76. Pukander J, Rautianen M. Penetration of azithromycin into middle ear effusions in acute and secretory otitis media in children. J Antimicrob Chemother 1996;37(Suppl C):53–61.

    PubMed  CAS  Google Scholar 

  77. Fraschini F, Braga PC, Scarpazza G, Scaglione F, Pignataro O, Sambataro G, et al. Human pharmacokinetics and distribution in various tissues of ceftriaxone. Chemotherapy 1986;32:192–199.

    Article  PubMed  CAS  Google Scholar 

  78. Rothermel CD. Single dose azithromycin for acute otitis media: A pharmacokinetic/pharmacodynamic rationale. Curr Ther Res 2003;64(Suppl A):A4–15.

    Article  CAS  Google Scholar 

  79. Craig WA. Pharmacokinetic/pharmacodynamic parameters: Rationale for antibacterial dosing of mice and men. Clin Infect Dis 1998;26:1–10.

    Article  PubMed  CAS  Google Scholar 

  80. Hopkins S. Clinical safety and tolerance of azithromycin in children. J Antimicrob Chemother 1993;31(Suppl E):111–117.

    PubMed  Google Scholar 

  81. Hoepelman IM, Schneider MME. Azithromycin: the first of the tissue-selective azalides. Int J Antimicrob Agents 1995;5:145–167.

    Article  PubMed  CAS  Google Scholar 

  82. Becker MH, Drachman RH, Kirscht JP. Predicting mothers’ compliance with pediatric medical regimens. J Pediatr 1972;81:843–854.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics and Clinical Epidemology, Sitaram Bhartia Institute of Science and Research, Qutab Institutional Area, New Delhi, 110 016, India

    Anjana Gulani & H. P. S. Sachdev

  2. Department of Child and Adolescent Health and Development, World Health Organization, 20 Avenue Appia, Geneva 27, CH1211, Switzerland

    Shamim A. Qazi

  3. E-6/12 Vasant Vihar, New Delhi, 110 057, India

    H. P. S. Sachdev

Authors
  1. Anjana Gulani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. P. S. Sachdev
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shamim A. Qazi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. P. S. Sachdev.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gulani, A., Sachdev, H.P.S. & Qazi, S.A. Efficacy of short course (<4 days) of antibiotics for treatment of acute otitis media in children: A systematic review of randomized controlled trials . Indian Pediatr 47, 74–87 (2010). https://doi.org/10.1007/s13312-010-0010-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-010-0010-9

Key Words

Search

Navigation