PEDIATRICS Vol. 102 No. 1 July 1998, pp. 157
Ruling Out Rival Explanations
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To the Editor.
In "Otitis Media-related Antibiotic Prescribing Patterns, Outcomes, and Expenditures in a Pediatric Medicaid Population," Berman et al present an ambitious effort to explore relationships in this important area.1 Otitis media (OM) is a common problem and a variety of antibiotics, often expensive, are routinely used to treat the condition. However, I question the authors' conclusions about what the outcomes component of their study reveals.
In their introduction, the authors stated that "clinical trials of
antibiotic treatment for acute otitis media fail to document the
superiority of any antibiotic," citing Rosenfeld et al's extensive metaanalysis of randomized antibiotic trials in children with OM.2 To evaluate the short-term effectiveness of
antibiotics for a large pediatric population, Berman et al examined
claims data for 12 281 Medicaid-enrolled children <30 months of age. The