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Effect of prior antibiotic treatment on middle ear disease in children
H Faden1, J Bernstein, L Brodsky
1Division of Infectious Diseases, State University of New York School of Medicine, Buffalo.
Abstract:
The effect of prior antibiotic treatment on the course of otitis media was assessed in a group of 62 children who experienced 83 episodes of ear infection during 3 years of observation. Bacterial quantitation in middle ear fluids demonstrated a significantly higher colony count in symptomatic children (3.9 x 10(4) +/- 12 bacteria per milliliter) compared to asymptomatic children (6.3 x 10(3) +/- 10 bacteria per milliliter; p = .05). Bacterial counts similarly tended to be higher in children with Streptococcus pneumoniae (4.0 x 10(6) +/- 16 bacteria per milliliter) and Hemophilus influenzae (2.0 x 10(6) +/- 16 bacteria per milliliter), who were more often symptomatic (73% and 55%, respectively, versus 38%) than children with Moraxella catarrhalis (7.9 x 10(3) +/- 2). Antibiotic therapy between 3 and 30 days prior to bacterial diagnosis was associated with a reduction in symptoms from 70% to 38% (p less than .025). However, prior treatment did not statistically reduce bacterial colony counts, although S pneumoniae decreased 90% in the previously treated group. Resistance to ampicillin occurred in 0% of S pneumoniae, 39% of nontypeable H influenzae, and 80% of M catarrhalis subjects without prior treatment and in 0%, 46%, and 100%, respectively, of subjects previously treated (p less than .025). These data suggest that prior treatment has a significant impact on the subsequent course of otitis media in children.
Insights
Prior antibiotic treatment in children with otitis media reduced symptoms but did not lower bacterial counts. However, it increased resistance to ampicillin in certain bacteria, impacting future ear infection courses.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Otitis media (middle ear infection) is common in children.
- The role of prior antibiotic exposure in otitis media course and bacterial resistance is not fully understood.
Purpose of the Study:
- To assess the effect of previous antibiotic treatment on the clinical course and bacterial characteristics of childhood otitis media.
Main Methods:
- Observational study of 62 children over 3 years, analyzing 83 episodes of otitis media.
- Bacterial quantitation in middle ear fluid.
- Assessment of symptom presence and antibiotic resistance patterns.
Main Results:
- Symptomatic children had significantly higher bacterial counts (3.9 x 10(4) vs. 6.3 x 10(3) bacteria/mL).
- Prior antibiotic therapy reduced symptom prevalence (70% to 38%) but did not significantly lower bacterial counts.
- Ampicillin resistance increased in previously treated children, particularly for nontypeable Haemophilus influenzae (39% to 46%) and Moraxella catarrhalis (80% to 100%).
Conclusions:
- Prior antibiotic treatment impacts the course of otitis media, reducing symptoms but potentially fostering antibiotic resistance.
- The findings highlight the complex relationship between antibiotic use and otitis media outcomes in pediatric populations.