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Acute-phase reactants and acute bacterial otitis media
M A Del Beccaro1, P M Mendelman, A F Inglis
1Emergency Services, Children's Hospital and Medical Center, Seattle, WA 98105.
Insights
Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are common in acute bacterial otitis media. These elevated levels may also indicate a higher risk of recurrent otitis media in children.
Area of Science:
- Pediatric infectious diseases
- Clinical immunology
- Biomarkers in infection
Background:
- Acute bacterial otitis media is a common childhood infection.
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are inflammatory markers.
- The role of ESR and CRP in uncomplicated otitis media requires clarification.
Purpose of the Study:
- To investigate if ESR and CRP levels are elevated in children with acute bacterial otitis media.
- To determine the association between elevated ESR or CRP and recurrent otitis media.
Main Methods:
- Investigator-blinded antibiotic efficacy trial in an urban children's hospital emergency department.
- Thirty-one children with acute bacterial otitis media symptoms (duration ≤7 days) were enrolled.
- Tympanocentesis, 10-day oral antibiotic treatment, and 30-day follow-up were performed.
Main Results:
- 55% of patients had elevated ESR (>20 mm/h) or CRP (>8 mg/L).
- 35% of patients experienced recurrent otitis media during follow-up.
- Elevated ESR or CRP was associated with an 8.24-fold increased risk of recurrence (P = .007).
Conclusions:
- Elevated ESR and CRP levels are consistent with acute bacterial otitis media.
- These inflammatory markers may indicate an increased risk of otitis media recurrence.
- ESR and CRP could potentially aid in assessing recurrence risk in future studies.
Objective:
To determine if the erythrocyte sedimentation rate and C-reactive protein level are elevated in uncomplicated acute bacterial otitis media.
Design:
Investigator-blinded, antibiotic efficacy trial.
Setting:
The emergency department of an urban regional children's hospital with 24,000 annual visits.
Participants:
Thirty-one children with symptoms of acute bacterial otitis media of 7 days' duration or less.
Selection Procedure:
Volunteer sample.
Interventions:
Tympanocentesis, oral antibiotics for 10 days, and three follow-up visits in the next 30 days.
Measurements/Results:
The erythrocyte sedimentation rate and C-reactive protein level were obtained at time of entry into the antibiotic study. Seventeen patients (55%; 95% confidence interval, 37% to 72%) had either an erythrocyte sedimentation rate above 20 mm/h or a C-reactive protein level above 8 mg/L. Eleven patients (35%) had a recurrent episode of acute bacterial otitis media during the follow-up period. The relative risk of recurrence of otitis media given an elevated erythrocyte sedimentation rate or C-reactive protein level was 8.24 (95% confidence interval, 1.20 to 56.74; Fisher's Exact Test; P = .007).
Conclusions:
Clinicians who use elevated acute-phase reactants as possible indicators of invasive bacterial infections should be aware that an elevated erythrocyte sedimentation rate or C-reactive protein level is also consistent with acute bacterial otitis media. An elevated erythrocyte sedimentation rate or C-reactive protein level also appears to be associated with an increased risk of recurrence of acute bacterial otitis media. If these findings can be confirmed in a larger study, the erythrocyte sedimentation rate or C-reactive protein level could be used to assess the risk of recurrent otitis media.