Abstract
Backgrounds/Objectives: Acute otitis media (AOM) is the leading reason antibiotics are prescribed to children. Despite guidelines advocating for watchful waiting and shorter antibiotic durations, overprescribing remains a concern. This meta-analysis aims to quantify potential reduction in antibiotic days of therapy (DOT) for AOM if prescribers adhered to guidelines. Methods: Cochrane databases were sourced for studies on ear infections, diagnostic accuracy, antibiotic duration, and watchful waiting. Randomized clinical trials, observational studies, and quality improvement reports of children aged 6 months-17 years with uncomplicated AOM published between 2000 and 2024 from the U.S., Canada, and Europe. Of 4187 studies, 425 met selection criteria. PRISMA guidelines were adhered to for independent extraction by multiple reviewers. Pooled prevalence of AOM outcomes and odds ratios (OR) for effectiveness interventions were calculated using the DerSimonian-Laird random effects model. A simulation study compared current practice to national guidelines. Results: Eighty-six studies found an estimated 107 million DOT prescribed to children in the U.S. annually for AOM. Following the American Academy of Pediatrics' guidelines could reduce DOT by 57.9 million days (54%). Adherence to NICE guidelines could reduce DOT by 74.1 million days (70%). Watchful waiting and short-course antibiotic interventions had pooled Ors of 4.35 and 7.12, respectively, for decreasing DOT. Conclusions: Adherence to guidelines for AOM management could avert millions of antibiotic DOT. Watchful waiting and short-duration interventions are most impactful on antibiotic overprescribing.