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Antibiotic treatment for children with acute otitis media (AOM) remains controversial because only about one in eight treated children benefit (i.e., have 1 to 2 fewer days of fever and pain during a 7-day period of illness). In a meta-analysis of data for placebo recipients in six randomized clinical trials of antibiotics for AOM, investigators identified predictors of a prolonged course (pain, fever, or both on days 3 to 7 after randomization).
Of the 824 controls (mean age, 3.4 years), 11% had fever at days 3 to 7, 31% had pain, and 37% had fever, pain, or both. Significant independent predictors of a prolonged course were age younger than 2 years (odds ratio, 2.1) and bilateral AOM (OR, 1.7). For example, 55% of children younger than 2 w…