What do systematic reviews say?

Antibiotics vs other antibiotics

• Antibiotics for acute maxillary sinusitis in adults 2014 · Cochrane Headline outcomes only
  no estimate extracted
  10 studies · 54 participants
  Moderate

Antibiotics vs placebo compared

Antibiotic therapy showed no clear difference in treatment harms (adverse events or side effects associated with… compared with placebo compared to placebo (low certainty).

• Antibiotic therapy versus no antibiotic therapy for children aged 2 to 59 months with WHO‐defined non‐severe pneumonia… 2021 · Cochrane Headline outcomes only
  RR 0.81 [0.6, 1.09]
  3 studies · 3253 participants
  Low

Antibiotics (short duration) vs prolonged‐course antibiotic therapy be used

• Short‐course versus prolonged‐course antibiotic therapy for hospital‐acquired pneumonia in critically ill adults 2015 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 431 participants
  Low

Antibiotics vs control ‐ primary outcomes

Antibiotic probably leads to lower prevention ‐ any AOM or CSOM during intervention compared with control ‐ primary outcomes (moderate certainty).

• Antibiotics for the prevention of acute and chronic suppurative otitis media in children 2006 · Cochrane Headline outcomes only
  RR 0.65 [0.53, 0.79]
  14 studies · 1461 participants
  Moderate

Antibiotics vs control ‐ secondary outcomes

Antibiotic showed no clear difference in side effects ‐ any clinical side effects during intervention compared with control ‐ secondary outcomes (moderate certainty).

• Antibiotics for the prevention of acute and chronic suppurative otitis media in children 2006 · Cochrane Headline outcomes only
  RR 1.99 [0.25, 15.89]
  12 studies · 817 participants
  Moderate

Summary of findings table ‐ Delayed antibiotics vs no antibiotics

Summary of findings table ‐ Delayed antibiotics probably leads to higher patient satisfaction: delayed (prescription collection) versus no… compared with no antibiotics (moderate certainty).

• Immediate versus delayed versus no antibiotics for respiratory infections 2023 · Cochrane Headline outcomes only
  OR 1.45 [1.08, 1.96]
  5 studies · 1523 participants
  Moderate

Summary of findings table ‐ Delayed antibiotics vs no antibiotics

Summary of findings table ‐ Delayed antibiotics showed no clear difference in reconsultation rate: delayed (all strategies) versus no antibiotics compared with no antibiotics (moderate certainty).

• Immediate versus delayed versus no antibiotics for respiratory infections 2023 · Cochrane Headline outcomes only
  OR 0.83 [0.46, 1.52]
  2 studies · 584 participants
  Moderate

Summary of findings table ‐ Delayed antibiotics vs no antibiotics

• Immediate versus delayed versus no antibiotics for respiratory infections 2023 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 674 participants
  Moderate

Summary of findings table ‐ Delayed antibiotics vs immediate antibiotics

Summary of findings table ‐ Delayed antibiotics probably leads to lower antibiotic use: delayed (all strategies) versus immediate antibiotics compared with immediate antibiotics (moderate certainty).

• Immediate versus delayed versus no antibiotics for respiratory infections 2023 · Cochrane Headline outcomes only
  OR 0.03 [0.01, 0.07]
  8 studies · 2257 participants
  Moderate

Summary of findings table ‐ Delayed antibiotics vs immediate antibiotics

Summary of findings table ‐ Delayed antibiotics showed no clear difference in patient satisfaction: delayed (all strategies) versus immediate… compared with immediate antibiotics (moderate certainty).

• Immediate versus delayed versus no antibiotics for respiratory infections 2023 · Cochrane Headline outcomes only
  OR 0.77 [0.45, 1.29]
  7 studies · 1927 participants
  Moderate

Summary of findings table ‐ Delayed antibiotics vs immediate antibiotics

Summary of findings table ‐ Delayed antibiotics showed no clear difference in reconsultation rate: delayed (all strategies) versus immediate… compared with immediate antibiotics (moderate certainty).

• Immediate versus delayed versus no antibiotics for respiratory infections 2023 · Cochrane Headline outcomes only
  OR 1.04 [0.66, 1.63]
  4 studies · 972 participants
  Moderate

Summary of findings table ‐ Delayed antibiotics vs immediate antibiotics

• Immediate versus delayed versus no antibiotics for respiratory infections 2023 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 1302 participants
  Low

Summary of findings table ‐ Delayed antibiotics vs no antibiotics

Summary of findings table ‐ Delayed antibiotics probably leads to higher antibiotic use: delayed (all strategies) versus no antibiotics compared with no antibiotics (moderate certainty).

• Immediate versus delayed versus no antibiotics for respiratory infections 2023 · Cochrane Headline outcomes only
  OR 2.52 [1.69, 3.75]
  5 studies · 1529 participants
  Moderate

Antibiotics vs placebo

Antibiotics showed no clear difference in pain ‐ pain at 24 hours compared with placebo (high certainty).

• Antibiotics for acute otitis media in children 2023 · Cochrane Headline outcomes only
  RR 0.89 [0.78, 1.01]
  5 studies · 1394 participants
  High

Antibiotics vs placebo

Antibiotics leads to lower pain ‐ pain at 2 to 3 days compared with placebo (high certainty).

• Antibiotics for acute otitis media in children 2023 · Cochrane Headline outcomes only
  RR 0.71 [0.58, 0.88]
  7 studies · 2320 participants
  High

Antibiotics vs placebo

Antibiotics showed no clear difference in pain ‐ pain at 4 to 7 days compared with placebo (high certainty).

• Antibiotics for acute otitis media in children 2023 · Cochrane Headline outcomes only
  RR 0.76 [0.5, 1.14]
  7 studies · 1264 participants
  High

Antibiotics vs placebo

Antibiotics probably leads to lower pain ‐ pain at 10 to 12 days compared with placebo (moderate certainty).

• Antibiotics for acute otitis media in children 2023 · Cochrane Headline outcomes only
  RR 0.33 [0.17, 0.66]
  1 study · 278 participants
  Moderate

Antibiotics vs placebo

Antibiotics leads to higher vomiting, diarrhoea or rash compared with placebo (high certainty).

• Antibiotics for acute otitis media in children 2023 · Cochrane Headline outcomes only
  RR 1.38 [1.16, 1.63]
  8 studies · 2107 participants
  High

Antibiotics vs placebo

Antibiotics leads to lower abnormal tympanometry ‐ 2 to 4 weeks compared with placebo (high certainty).

• Antibiotics for acute otitis media in children 2023 · Cochrane Headline outcomes only
  RR 0.83 [0.72, 0.96]
  7 studies · 2138 participants
  High

Antibiotics vs placebo

Antibiotics showed no clear difference in abnormal tympanometry ‐ 3 months compared with placebo (high certainty).

• Antibiotics for acute otitis media in children 2023 · Cochrane Headline outcomes only
  RR 0.94 [0.66, 1.34]
  3 studies · 809 participants
  High