What do systematic reviews say?

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

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 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 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 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

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