Antibiotics and Acute Otitis Media in Children—Reply

In Reply: Because of space constraints, some analyses we conducted had to be left out of our article. Our Evidence Report¹ assessed the data concerning the effect of age and laterality on the effectiveness of antibiotic therapy, and it included a detailed discussion of the individual patient data meta-analysis by Rovers et al,² along with other evidence not included in that analysis and new meta-analyses we conducted ourselves. We concluded that both younger patients and those with bilateral disease have worse outcomes regardless of therapy and that “for uncomplicated acute otitis media, the available evidence indicates that the treatment effect may be modified by age and laterality.” However, for the latter conclusion, we did not view the strength of evidence as strong, as the better treatment effect in patients younger than 2 years and with bilateral disease reported by Rovers et al has yet to be assessed prospectively in a controlled trial.