Summary of Conclusions and Associated Strength of Evidence Dispositions

ConclusionStrength of EvidenceComments
Effectiveness of earplugs or avoidance of swimming.
 Neither use of ear plugs nor avoidance of swimming reduces the risk of otorrhea.LowLimited number of studies (2 RCTs)
Meta-analysis of 7 NRCSs with high risk of bias
Key question 5: effectiveness of topical antibiotic drops versus systemic antibiotics or watchful waiting.
 Topical antibiotic–glucocorticoid drops and topical antibiotic drops are superior to watchful waiting in achieving clinical cure of otorrhea.ModerateNetwork meta-analysis
OR: 12.0 (CrI, 1.9–82) (antibiotic–glucocorticoid)
OR: 7.2 (CrI, 1.2–51.0) (antibiotic only)
 Topical antibiotic–glucocorticoid drops are superior to oral antibiotics in achieving clinical cure.ModerateNetwork meta-analysis
OR: 5.3 (CrI, 1.2–27.0)
 Topical antibiotic drops without glucocorticoid are superior to oral antibiotics in achieving clinical cure.LowNetwork meta-analysis
OR: 3.3 (CrI, 0.75–16.0)
(95% probability 1 of 2 most effective interventions)