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Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long\u2010term effects and contribution to global antibiotic resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and Setting<\/jats:title><jats:p>A comprehensive literature search was undertaken using Medline (1946\u2013October 2023) and Embase (1974\u2013October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children &lt;\u200918\u2009years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta\u2010analysis was carried out using random\u2010effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the <jats:italic>I<\/jats:italic>\n<jats:sup>2<\/jats:sup> statistic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes. Secondary outcomes: assessment of antimicrobial agents and outcomes in children with risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Assessment of qualitative data was performed on 20 studies (<jats:italic>n<\/jats:italic>\u2009=\u20092210). No controlled trials were identified post\u2010multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. Quantitative meta\u2010analysis on nine pre\u2010PCV studies (<jats:italic>n<\/jats:italic>\u2009=\u20091087) demonstrated antimicrobial chemoprophylaxis reduced any episode of AOM with a risk ratio 0.59 (95% CI 0.45\u20130.77).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Families and clinicians must balance marginal short\u2010medium term benefit (based on pre\u2010PCV data), and the potential for adverse effects to that individual, and the societal risk of antimicrobial resistance with prolonged antibiotic use.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.14240","type":"journal-article","created":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T09:45:01Z","timestamp":1728726301000},"page":"1-14","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Systematic Review and Meta\u2010Analysis of the Efficacy of Antimicrobial Chemoprophylaxis for Recurrent Acute Otitis Media in Children"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2395-2146","authenticated-orcid":false,"given":"Timothy","family":"Davies","sequence":"first","affiliation":[{"name":"Department of Paediatric Otolaryngology Alder Hey Children's Hospital  Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xicheng","family":"Peng","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute Newcastle University  Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Salem","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology St Georges University Hospital NHS Foundation Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeynep C.","family":"Elcioglu","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute Newcastle University  Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Kremneva","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology St Georges University Hospital NHS Foundation Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei\u2010yin","family":"Gruber","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology St Georges University Hospital NHS Foundation Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristijonas","family":"Milinis","sequence":"additional","affiliation":[{"name":"Department of Paediatric Otolaryngology Alder Hey Children's Hospital  Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7972-7111","authenticated-orcid":false,"given":"Michael W.","family":"Mather","sequence":"additional","affiliation":[{"name":"Department of Paediatric Otolaryngology Great North Children's Hospital  Newcastle upon Tyne UK"},{"name":"Biosciences Institute Newcastle University  Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1199-8406","authenticated-orcid":false,"given":"Jason","family":"Powell","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute Newcastle University  Newcastle upon Tyne UK"},{"name":"Department of Paediatric Otolaryngology Great North Children's Hospital  Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Paediatric Otolaryngology Alder Hey Children's Hospital  Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.63"},{"issue":"137","key":"e_1_2_12_3_1","first-page":"1","article-title":"Ambulatory Health Care Visits by Children: Principal Diagnosis and Place of Visit","volume":"13","author":"Freid V. 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