A Cochrane review «Influenza vaccines for preventing acute otitis media in infants and children»1 «Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev 2017;10():CD010089. »1 included 11 studies with a total of 17123 children. Six trials were carried out in high-income countries and 5 were multicentre trials in high-, middle-, and low-income countries. The children were aged 6 months to 6 years, with or without a history of recurrent acute otitis media (AOM). The primary outcome showed a small reduction in at least one episode of AOM over at least 6 months of follow-up (RR 0.84, 95% CI 0.69 to 1.02; RD -0.04, 95% CI -0.08 to -0.00; 4 trials, n=3134), meaning that there was a 4% absolute reduction in episodes of AOM among vaccinated children. The subgroup analyses (i.e. number of courses and types of vaccine administered) showed no differences. There was a reduction in the use of antibiotics in vaccinated children (RR 0.70, 95% CI 0.59 to 0.83; RD -0.11, 95% CI -0.16 to -0.06; 2 trials, n=1223). It was not possible to demonstrate whether there was any difference in the utilisation of health care. The use of influenza vaccine resulted in a significant increase in fever (RR 1.15, 95% CI 1.06 to 1.24; RD 0.02, 95% CI 0.00 to 0.04; 7 trials, n=10615) and rhinorrhoea (RR 1.17, 95% CI 1.07 to 1.29; RD 0.09, 95% CI 0.01 to 0.16; 6 trials, n=10563), but no difference in pharyngitis. No major adverse events were reported.
The observed reduction in the use of antibiotics needs to be considered in light of current recommended practices aimed at avoiding antibiotic overuse.