Cochrane · systematic review · CD013052
Systemic antibiotics for chronic suppurative otitis media
Chong, L-Y, Head, K, Webster, KE, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
ENTAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
29
current version
GRADE rated
15
No studies
14
Included studies
NR
No studies 14 · 48.3%Ungraded 0 · 0%Very low 14 · 48.3%Low 1 · 3.4%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Systemic antibiotics compared to no treatment/placebo
Population: children with CSOM
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Resolution of ear discharge ‐ measured at 1 to 2 weeks Systemic antibiotics vs no treatment/placebo | RR 8.47 [1.88, 38.21] | 1 study · 33 participants | Very low Downgraded: risk of bias |
Resolution of ear discharge ‐ measured after 4 weeks Systemic antibiotics vs no treatment/placebo | no estimate extracted | NR | No studies |
Health‐related quality of life Systemic antibiotics vs no treatment/placebo | no estimate extracted | NR | No studies |
Ear pain (otalgia) or discomfort or local irritation Systemic antibiotics vs no treatment/placebo | no estimate extracted | NR | No studies |
Hearing Systemic antibiotics vs no treatment/placebo | no estimate extracted | 1 study · 33 participants | Very low Downgraded: risk of bias |
Serious complications ‐ during 6 months of Systemic antibiotics vs no treatment/placebo | no estimate extracted | 1 study · 33 participants | Very low Downgraded: risk of bias |
Suspected ototoxicity Systemic antibiotics vs no treatment/placebo | no estimate extracted | NR | No studies |
Systemic antibiotics compared to no treatment or placebo on top of topical antibiotics for CSOM
Population: people (of any age) with CSOM
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Resolution of ear discharge ‐ measured at 1 to 2 weeks Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | RR 1.02 [0.93, 1.12] | 5 studies · 390 participants | Low Downgraded: risk of bias, imprecision |
Resolution of ear discharge ‐ measured after 4 weeks Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | no estimate extracted | NR | No studies |
Health‐related quality of life Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | no estimate extracted | NR | No studies |
Ear pain (otalgia) or discomfort or local irritation ‐ measured at 1 week Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | RR 1 [0.21, 4.72] | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Hearing Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | no estimate extracted | NR | No studies |
Serious complications ‐ measured at 19 to 24 days Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | no estimate extracted | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Suspected ototoxicity ‐ measured at 10 days to 3 weeks Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | RR 3 [0.13, 71.92] | 3 studies · 250 participants | Very low Downgraded: risk of bias, imprecision |
Systemic antibiotics compared to no treatment or placebo on top of topical antibiotics for CSOM
Population: people with CSOM; one study included patients of unknown age; one study included children with CSOM who had not responded to initial antibiotic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Resolution of ear discharge ‐ measured at 1 to 2 weeks Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | no estimate extracted | NR | No studies |
Resolution of ear discharge ‐ measured after 4 weeks (4 weeks) (Metronidazole plus gentamicin‐steroid drops compared to gentamicin‐steroid alone) Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | RR 0.91 [0.51, 1.65] | 1 study · 30 participants | Very low Downgraded: risk of bias, imprecision |
Resolution of ear discharge ‐ measured after 4 weeks (6 weeks) (Oral trimethoprim/sulfamethoxazole plus topical antibiotics and steroid ear drops compared to topical antibiotic and steroid ear drops alone) Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | RR 1.54 [1.09, 2.16] | 1 study · 98 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Health‐related quality of life ‐ unclear Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | no estimate extracted | 1 study · 101 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Ear pain (otalgia) or discomfort or local irritation Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | no estimate extracted | NR | No studies |
Hearing ‐ unclear Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | no estimate extracted | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Serious complications ‐ mastoid abscess measured at 12 weeks Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | RR 1.02 [0.07, 15.86] | 1 study · 101 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Suspected ototoxicity Systemic antibiotics vs no treatment or placebo on top of topical antibiotics | no estimate extracted | NR | No studies |
Systemic antibiotics compared to no treatment or placebo on top of topical antiseptics for CSOM
Population: schoolchildren with CSOM
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Resolution of ear discharge ‐ measured between 1 week and up to 2 weeks Systemic antibiotics vs no treatment or placebo on top of topical antiseptics | no estimate extracted | NR | No studies |
Resolution of ear discharge (4 weeks or more) ‐ measured at 3 to 4 months Systemic antibiotics vs no treatment or placebo on top of topical antiseptics | RR 1.03 [0.75, 1.41] | 1 study · 136 participants | Very low Downgraded: risk of bias, imprecision |
Health‐related quality of life Systemic antibiotics vs no treatment or placebo on top of topical antiseptics | no estimate extracted | NR | No studies |
Ear pain (otalgia) or discomfort or local irritation Systemic antibiotics vs no treatment or placebo on top of topical antiseptics | no estimate extracted | NR | No studies |
Hearing ‐ measured at 3 to 4 months Systemic antibiotics vs no treatment or placebo on top of topical antiseptics | no estimate extracted | 1 study · 204 participants | Very low Downgraded: risk of bias, imprecision |
Serious complications Systemic antibiotics vs no treatment or placebo on top of topical antiseptics | no estimate extracted | NR | No studies |
Suspected ototoxicity Systemic antibiotics vs no treatment or placebo on top of topical antiseptics | no estimate extracted | 1 study · 204 participants | Very low Downgraded: risk of bias, imprecision |