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Pediatric Drugs

Published in:

01-11-2006 | Current Opinion

Acute Otitis Media in Children Aged Less Than 2 Years

Drug Treatment Issues

Author: Dr Eugene Leibovitz

Published in: Pediatric Drugs | Issue 6/2006

Abstract

The management of acute otitis media (AOM) in childhood has evolved considerably during recent years as a result of the new insights provided by publication (in 2004) of the American Academy of Pediatrics and the American Academy of Family Physicians guidelines for the treatment of AOM. The new treatment guidelines establish a clear hierarchy among the various antibacterials used in the treatment of this disease and also the use of an age-stratified approach to AOM by recommending an observation strategy (‘watchful waiting’) without the use of antibacterials for some groups of patients with AOM. Infants and young children aged <2 years represent a target population characterized by a high incidence of AOM (and in particular of recurrent disease), lack of anatomic and physiologic maturity of airways, age-related immune humoral and cellular deficiencies, the presence of antibacterial-resistant pathogens, and a less efficient response to antibacterial treatment. Presently, the evidence accumulated in the literature is not sufficient to conclude that the role of antibacterials is only minimal in the management of AOM and that the watchful waiting policy is the most appropriate choice for patients aged <2 years with a certain AOM diagnosis. However, adherence to such a policy in patients with an uncertain or questionable AOM diagnosis and/or mild-to-moderate symptoms, in addition to its implementation in patients aged >2 years, could reduce substantially the use of antibacterials in children and play a major role in the strategy of decreasing antibacterial resistance.

Faden H, Duffy L, Boeve M. Otitis media: back to basics. Pediatr Infect Dis J 1998; 17: 105–13

Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989; 160: 83–94PubMedCrossRef

McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA 2002; 287: 3096–102PubMedCrossRef

Kero P, Piekkala P. Factors affecting the occurrence of acute otitis media during the first year of life. Acta Paediatr Scand 1987; 76: 718–23CrossRef

Paradise JL, Rockette HE, Colborn DK, et al. Otitis media in 2,253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics 1997; 99: 318–33PubMedCrossRef

Faden H. The microbiologic and immunologic basis for recurrent otitis media in children. Eur J Pediatr 2001; 160: 407–13PubMedCrossRef

Del Beccaro MA, Mendelman PM, Inglis AF, et al. Bacteriology of acute otitis media: a new perspective. J Pediatr 1992; 120: 81–4PubMedCrossRef

Bluestone CD, Stephenson JS, Martin LM. Ten-year review of otitis media pathogens. Pediatr Infect Dis J 1992; 11: S7–11PubMedCrossRef

Pichichero ME, Pichichero CL. Persistent acute otitis media: I. Causative pathogens. Pediatr Infect Dis J 1995; 14: 178–83PubMedCrossRef

10.

Jacobs MR, Dagan R, Appelbaum PC, et al. Prevalence of antimicrobial-resistant pathogens in middle ear fluid: multinational study of 917 children with acute otitis media. Antimicrob Agents Chemother 1998; 42: 589–95PubMed

11.

Kaleida PH, Casselbrant ML, Rockette HE, et al. Amoxicillin or myringotomy or both for acute otitis media: results of a randomized clinical trial. Pediatrics 1991; 87: 466–74PubMed

12.

Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media; metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr 1994; 124: 355–67PubMedCrossRef

13.

Dowell SF, Marcy MS, Phillips WR, et al. Otitis media: principles of judicious use of antimicrobials agents. Pediatrics 1998; 101: 165–71

14.

Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001; 344: 403–9PubMedCrossRef

15.

American Academy of Pediatrics and American Academy of Family Physicians. Clinical practice guideline: Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004; 113: 1451–65CrossRef

16.

Casey J, Pichichero ME. Changes in frequency and pathogens causing acute otitis media in 1995–2003. Pediatr Infect Dis J 2004; 23: 824–8PubMedCrossRef

17.

Block SL, Hedrick J, Harrison CJ, et al. Community-wide vaccination with the heptavalent pneumococcal conjugate alters the microbiology of acute otitis media. Pediatr Infect Dis J 2004; 23: 829–33PubMedCrossRef

18.

van Buchem FL, Peeters MF, Van’t Hof MA. Acute otitis media: a new treatment strategy. BMJ 1985; 290: 1033–7PubMedCrossRef

19.

Froom J, Culpepper L, Jacobs M, et al. Antimicrobials for acute otitis media? A review from the International Primary Care Network. BMJ 1997; 315: 98–102PubMedCrossRef

20.

Teele DW, Klein JO, Chase C, et al. Otitis media in infancy and intellectual ability, school achievement, speech, and language at age 7 years. J Infect Dis 1990; 162: 546–9CrossRef

21.

Marchand CD, Shurin PA, Turczyk VA, et al. Course and outcome of otitis media in early infancy: a prospective study. J Pediatr 1984; 104(6): 826–31CrossRef

22.

Lanphear BP, Byrd RS, Auinger P, et al. Increasing prevalence of recurrent acute otitis media among children in the United States. Pediatrics 1997; 99: E1PubMedCrossRef

23.

Auinger P, Lanphear BP, Kalkwarf HJ, et al. Trends in otitis media among children in the United States. Pediatrics 2003; 112: 514–20PubMedCrossRef

24.

Capra AM, Lieu TA, Black SB, et al. The costs of otitis media in a managed care population. Pediatr Infect Dis J 2000; 19: 354–5PubMedCrossRef

25.

Bondy J, Berman S, Glazner J, et al. Direct expenditures related to otitis media diagnoses: extrapolations from a pediatric Medicaid cohort. Pediatrics 2000; 105(6): E72PubMedCrossRef

26.

Paradise JL. Otitis media in infants and children. Pediatrics 1980; 65: 917–43PubMed

27.

Sanders EA, Tenbergen-Meekes AM, Voorhorst-Ogink MM, et al. Immunoglobulin isotype-specific antibody responses to pneumococcal polysaccharide vaccine in patients with recurrent respiratory tract infections. Pediatr Res 1995; 37: 812–9PubMedCrossRef

28.

Ogra PL, Barenkamp SJ, DeMaria TF, et al. Recent advances in otitis media: 6. Microbiology and immunology. Ann Otol Rhinol Laryngol 2002; 111: 62–81

29.

Grain MJ, Waltman WD, Turner JS, et al. Pneumococcal surface protein A (PspA) is serologically highly variable and is expressed by all clinically important capsular serotypes of Streptococcus pneumoniae. Infect Immun 1996; 58: 3293–9

30.

Yamanaka N, Faden H. Antibody response to outer membrane protein of nontypeable Haemophilus influenzae in otitis-prone children. J Pediatr 1993; 122: 212–8PubMedCrossRef

31.

Yellon RF, Doyle WJ, Whiteside TL, et al. Cytokines, immunoglobulin and bacterial pathogens in middle ear effusions. Arch Otolaryngol Head Neck Surg 1995; 121: 865–9PubMedCrossRef

32.

Turner D, Leibovitz E, Aran A, et al. Acute otitis media in infants younger than two months of age: microbiology, clinical presentation and therapeutic approach. Pediatr Infect Dis J 2002; 21: 669–74PubMedCrossRef

33.

Carlin SA, Marchand CD, Shurin OA, et al. Host factors and early therapeutic response in acute otitis media. J Pediatr 1991; 118: 178–83PubMedCrossRef

34.

Hoberman A, Paradise JL, Burch DJ, et al. Equivalent efficacy and reduced occurrence of diarrhea from a new formulation of amoxicillin/clavulanate potassium (Augmentin) for treatment of acute otitis media in children. Pediatr Infect Dis J 1997; 16: 463–70PubMedCrossRef

35.

Karma P, Luotononen P, Pukander J, et al. Haemophilus influenzae in acute otitis media. Acta Otolaryngol 1983; 95: 105–10PubMedCrossRef

36.

Kilpi T, Herva E, Kaijalainen T, et al. Bacteriology of acute otitis media in a cohort of Finnish children followed for the first two years of life. Pediatr Infect Dis J 2001; 20: 654–62PubMedCrossRef

37.

Block SL. Management of acute otitis media in the 1990s: the decade of resistant pneumococcus. Pediatr Drugs 1999; 1(1): 31–50CrossRef

38.

Leibovitz E, Raiz E, Piglansky L, et al. Resistance pattern of middle ear fluid isolates in acute otitis media recently treated with antibiotics. Pediatr Infect Dis J 1998; 17: 463–9PubMedCrossRef

39.

Rodriguez WJ, Schwartz RH. Streptococcus pneumoniae causes otitis media with higher fever and more redness of tympanic membranes than Haemophilus influenzae or Moraxella catarrhalis. Pediatr Infect Dis J 1999; 18: 942–4PubMedCrossRef

40.

Palmu AA, Herva E, Savolainen H, et al. Association of clinical signs and symptoms with bacterial findings in acute otitis media. Clin Infect Dis 2004; 83: 234–42CrossRef

41.

Klein JO. The ‘in vivo sensitivity test’ for acute otitis media revisited. Pediatr Infect Dis J 1998; 17: 774–5PubMedCrossRef

42.

Del Mar C, Glasziou P, Hayem M. Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ 1997; 314: 1526–9PubMedCrossRef

43.

Takata G, Chan LS, Shekelle P, et al. Evidence assessment of management of acute otitis media: I. The role of antibiotics in treatment of uncomplicated acute otitis media. Pediatrics 2001; 108(2): 239–47PubMedCrossRef

44.

Dagan R, McCracken Jr GH. Flaws in design and conduct of clinical trials in acute otitis media. Pediatr Infect Dis J 2002; 21: 894–902PubMedCrossRef

45.

Wald E. Acute otitis media: more trouble with the evidence. Pediatr Infect Dis J 2003; 22: 103–4PubMed

46.

Harsten G, Prellenr K, Heldrup J, et al. Treatment failure in acute otitis media: a clinical study of children during their first three years of life. Acta Otolaryngol (Stockh) 1989; 108: 253–8CrossRef

47.

Appelman CL, Claessen JQ, Touw-Otten FW, et al. Co-amoxiclav in recurrent acute otitis media: placebo controlled study. BMJ 1991; 303: 1450–2PubMedCrossRef

48.

Dagan R, Leibovitz E. Bacterial eradication in the treatment of acute otitis media. Lancet Infect Dis 2002; 2: 593–604PubMedCrossRef

49.

Piglansky L, Leibovitz E, Raiz S, et al. The bacteriologic and clinical efficacy of high-dose amoxicillin as first-line therapy for acute otitis media in children. Pediatr Infect Dis J 2003; 22(5): 405–12PubMed

50.

Dagan R, Johnson CE, McLinn S, et al. Bacteriologic and clinical efficacy of amoxicillin/clavulanate vs azithromycin in acute otitis media. Pediatr Infect Dis J 2000; 19: 95–104PubMedCrossRef

51.

Hobermann A, Dagan R, Leibovitz E, et al. Large dosage amoxicillin/clavulanate compared with azithromycin for the treatment of bacterial acute otitis media in children. Pediatr Infect Dis J 2005; 24(6): 525–32CrossRef

52.

Leibovitz E, Piglansky L, Raiz S, et al. The bacteriologic efficacy of 1-day versus 3-day intramuscular ceftriaxone in the treatment of non-responsive acute otitis media. Pediatr Infect Dis J 2000; 19: 1040–5PubMedCrossRef

53.

Leiberman A, Leibovitz E, Piglansky L, et al. The bacteriologic and clinical efficacy of trimethoprim/sulfamethoxazole in the treatment of acute otitis media in children. Pediatr Infect Dis J 2001; 20: 260–4PubMedCrossRef

54.

Arguedas A, Sierra H, Soley C, et al. Activity of trimethoprim-sulfamethoxazole against middle ear fluid pathogens obtained from Costa Rican children with otitis media. Pediatr Infect Dis J 2005; 24: 839–41PubMedCrossRef

55.

Dagan R, Leibovitz E, Greenberg D, et al. Early eradication of pathogens from middle ear fluid is associated with improved clinical outcome. Pediatr Infect Dis J 1998; 17: 76–82

56.

Leibovitz E, Piglansky L, Raiz S, et al. Bacteriological and clinical efficacy of oral gatifloxacin in the treatment of recurrent/non-responsive acute otitis media: an open-label, single center, non-comparative, double tympanocentesis study. Pediatr Infect Dis J 2003; 22: 1–7CrossRef

57.

Noel GJ, Leibovitz E, Dagan R, et al. Levofloxacin therapy for infants and young children with persistent or recurrent acute otitis media [abstract no. G-2081]. 43th Interscience Conference on Antimicrobial Agents and Chemotherapy; 2004 Oct 30–Nov 2; Washington, DC: 267

58.

Dagan R, Leibovitz E, Greenberg D, et al. Early eradication of pathogens from middle ear fluid during antibiotic treatment of acute otitis media is associated with improved clinical outcome. Pediatr Infect Dis J 1998; 17: 776–82PubMedCrossRef

59.

Asher E, Greenberg D, Dagan R, et al. Failure to eradicate otitis media pathogens after 3–5 days of treatment is associated with higher relapse rate in children with initial improvement/cure [abstract no. G-2096]. 44th Interscience Conference on Antimicrobial Agents and Chemotherapy; 2004 Oct 30–Nov 2; Washington, DC: 271

60.

Olson LC, Jackson MA. Only the pneumococcus. Pediatr Infect Dis J 1999; 81: 849–50

61.

Leibovitz E, Jacobs MR, Dagan R. Haemophilus influenzae: a significant pathogen in acute otitis media. Pediatr Infect Dis J 2004; 23: 1142–55PubMed

62.

Dagan R, Hoberman A, Johnson C, et al. Bacteriologic and clinical efficacy of high dose amoxicillin/clavulanate in children with acute otitis media. Pediatr Infect Dis J 2001; 20: 829–37PubMedCrossRef

63.

Leibovitz E, Dagan R, Arguedas A, et al. Evaluation of once daily cefdinir 25 mg/kg oral suspension in children with acute otitis media at risk of persistent or recurrent otitis media. Paper presented at 14th European Congress of Clinical Microbiology and Infectious Diseases; 2004 May 1–4; Prague

64.

Arguedas A, Loaiza C, Soley C. Single dose azithromycin for the treatment of uncomplicated otitis media. Pediatr Infect Dis J 2004; 23(2): S108–14PubMed

65.

Arguedas A, Emparanza P, Schwartz RH, et al. A randomized, multicenter, double blind, double dummy trial of single dose azithromycin versus high dose amoxicillin for treatment of uncomplicated acute otitis media. Pediatr Infect Dis J 2005; 24(2): 153–61PubMedCrossRef

66.

Cohen R, Levy C, Boucherat M, et al. A multicenter, randomized, double-blind trial of 5 versus 10 days of antibiotic therapy for acute otitis media in young children. J Pediatr 1998; 133: 634–9PubMedCrossRef

67.

Cohen R, Levy C, Boucherat M, et al. Five vs ten days of antibiotic therapy for acute otitis media in young children. Pediatr Infect Dis J 2000; 19: 458–63PubMedCrossRef

68.

Hoberman A, Paradise JL, Cohen R. Duration of therapy for acute otitis media. Pediatr Infect Dis J 2000; 19(5): 471–3PubMedCrossRef

69.

van Buchem FL. Therapy of acute otitis media: myringotomy, antibiotics, or neither? Lancet 1981; II: 883–7CrossRef

70.

Damoiseaux RAMJ, van Bulen FAM, Hoes AW, et al. Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years. BMJ 2000; 420: 350–4CrossRef

71.

Little P, Gould C, Williamson I, et al. Pragmatic randomized controlled trial of two prescribing strategies for childhood acute otitis media. BMJ 2001; 322: 336–42PubMedCrossRef

72.

Little P, Gould C, Moore M, et al. Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomized trial. BMJ 2002; 325: 1–6CrossRef

73.

Le Saux N, Gaboury I, Baird M, et al. A randomized, double-blind, placebo-controlled noninferiority trial of amoxicillin for clinically diagnosed acute otitis media in children 6 months to 5 years of age. CMAJ 2005; 17: 335–41

74.

McCormick DP, Chonmaitree T, Pittman C, et al. Nonsevere acute otitis media: a clinical trial comparing outcomes of watchful waiting versus immediate antibiotic treatment. Pediatrics 2005; 115: 1455–65PubMedCrossRef

75.

Kaplan B, Wandstrat TL, Cunningham JR. Overall cost in the treatment of otitis media. Pediatr Infect Dis J 1997; 16: S9–11PubMedCrossRef

76.

Garbutt J, Jeffe DB, Shackelford P. Diagnosis and treatment of acute otitis media: an assessment. Pediatrics 2003; 112: 143–9PubMedCrossRef

77.

Finkelstein JA, Stille CJ, Rifas-Shiman SL, et al. Watchful waiting for acute otitis media: are parents and physicians ready? Pediatrics 2005; 115: 1466–73PubMedCrossRef

Title: Acute Otitis Media in Children Aged Less Than 2 Years
Drug Treatment Issues
Author: Dr Eugene Leibovitz
Publication date: 01-11-2006
Publisher: Springer International Publishing
Published in: Pediatric Drugs / Issue 6/2006
Print ISSN: 1174-5878
Electronic ISSN: 1179-2019
DOI: https://doi.org/10.2165/00148581-200608060-00002

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acute Otitis Media in Children Aged Less Than 2 Years

Drug Treatment Issues

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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