What do systematic reviews say?

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

Antibiotics vs placebo

Antibiotics leads to higher cure in adults with clinically diagnosed acute rhinosinusitis compared with placebo (high certainty).

• Antibiotics for acute rhinosinusitis in adults 2018 · Cochrane Headline outcomes only
  OR 1.25 [1.02, 1.54]
  8 studies · 1687 participants
  High

Antibiotics vs placebo

Antibiotics probably leads to higher cure in adults with acute rhinosinusitis confirmed by radiography1 compared with placebo (moderate certainty).

• Antibiotics for acute rhinosinusitis in adults 2018 · Cochrane Headline outcomes only
  OR 1.57 [1.03, 2.39]
  3 studies · 394 participants
  Moderate

Antibiotics vs placebo

Antibiotics probably leads to higher cure in adults with acute rhinosinusitis confirmed by computed… compared with placebo (moderate certainty).

• Antibiotics for acute rhinosinusitis in adults 2018 · Cochrane Headline outcomes only
  OR 4.89 [1.75, 13.72]
  1 study · 127 participants
  Moderate

Antibiotics vs placebo

Antibiotics leads to higher severity or duration of different clinical symptoms: resolution of… compared with placebo (high certainty).

• Antibiotics for acute rhinosinusitis in adults 2018 · Cochrane Headline outcomes only
  OR 1.58 [1.13, 2.22]
  3 studies · 660 participants
  High

Antibiotics vs placebo

Antibiotics leads to higher side effects: total compared with placebo (high certainty).

• Antibiotics for acute rhinosinusitis in adults 2018 · Cochrane Headline outcomes only
  OR 2.21 [1.74, 2.82]
  10 studies · 1816 participants
  High

Antibiotics vs placebo

Antibiotics leads to higher side effects: diarrhoea compared with placebo (high certainty).

• Antibiotics for acute rhinosinusitis in adults 2018 · Cochrane Headline outcomes only
  Peto OR 2 [1.41, 2.85]
  7 studies · 1210 participants
  High

Antibiotics vs placebo

Antibiotics leads to lower clinical failure compared with placebo (high certainty).

• Antibiotics for acute rhinosinusitis in adults 2018 · Cochrane Headline outcomes only
  Peto OR 0.48 [0.36, 0.63]
  12 studies · 2603 participants
  High

Antibiotics vs placebo

Antibiotics probably leads to lower clinical failure rate compared with placebo (moderate certainty).

• Antibiotics for acute maxillary sinusitis in adults 2014 · Cochrane Headline outcomes only
  RR 0.66 [0.47, 0.94]
  5 studies · 1084 participants
  Moderate
• Antibiotics for acute maxillary sinusitis in adults 2014 · Cochrane Headline outcomes only
  RR 0.85 [0.36, 1.98]
  1 study · 169 participants
  Low

Antibiotics vs placebo

• Antibiotics for acute maxillary sinusitis in adults 2014 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  Very low

Gastrointestinal adverse events in people taking macrolide antibiotics vs placebo

Other adverse events in people taking macrolide antibiotics showed no clear difference in deaths compared with placebo (low certainty).

• Adverse events in people taking macrolide antibiotics versus placebo for any indication 2019 · Cochrane Headline outcomes only
  OR 0.96 [0.87, 1.06]
  52 studies · 216246 participants
  Low

Gastrointestinal adverse events in people taking macrolide antibiotics vs placebo

It is very uncertain whether other adverse events in people taking macrolide antibiotics changes cardiac disorders compared with placebo (very low certainty).

• Adverse events in people taking macrolide antibiotics versus placebo for any indication 2019 · Cochrane Headline outcomes only
  OR 0.87 [0.54, 1.4]
  7 studies · 1715 participants
  Very low

Gastrointestinal adverse events in people taking macrolide antibiotics vs placebo

Other adverse events in people taking macrolide antibiotics showed no clear difference in hearing loss compared with placebo (low certainty).

• Adverse events in people taking macrolide antibiotics versus placebo for any indication 2019 · Cochrane Headline outcomes only
  OR 1.3 [1, 1.7]
  4 studies · 1369 participants
  Low

Gastrointestinal adverse events in people taking macrolide antibiotics vs placebo

Other adverse events in people taking macrolide antibiotics may leads to higher taste disturbance compared with placebo (low certainty).

• Adverse events in people taking macrolide antibiotics versus placebo for any indication 2019 · Cochrane Headline outcomes only
  OR 4.95 [1.64, 14.93]
  5 studies · 932 participants
  Low