Related Experiment Videos
Antimicrobial prophylaxis for recurrent acute otitis media
1Ambulatory Care Center, Children's Hospital of Pittsburgh, PA 15213-3417.
Insights
Antimicrobial prophylaxis significantly reduces acute otitis media recurrences in children. While not eliminating middle ear fluid, it remains a logical first-line treatment for recurrent ear infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Recurrent otitis media is a common childhood illness.
- Antimicrobial prophylaxis has been used since the 1960s to manage recurrent otitis media.
- Previous studies show mixed results regarding its efficacy.
Purpose of the Study:
- To evaluate the effectiveness of antimicrobial prophylaxis in reducing acute otitis media (AOM) episodes.
- To assess the impact of prophylaxis on middle ear effusion (MEE).
Main Methods:
- Review of uncontrolled and controlled studies on antimicrobial prophylaxis for recurrent otitis media.
- Analysis of data on acute otitis media recurrence rates and time with middle ear effusion.
Main Results:
- Antimicrobial prophylaxis substantially lowers the rate of acute otitis media recurrences compared to controls.
- Prophylaxis does not appear to reduce the cumulative proportion of time with middle ear effusion.
- Various antimicrobial drugs, including sulfonamides and aminopenicillins, have been studied.
Conclusions:
- Antimicrobial prophylaxis is an effective strategy for reducing acute otitis media recurrences in children.
- Further research is needed on drug choice, dosage, duration, and resistance.
- Currently, antimicrobial prophylaxis is considered the most logical initial management approach for recurrent otitis media.
Abstract:
Antimicrobial prophylaxis for recurrent otitis media was first reported in 1960 in an uncontrolled study using a long-acting sulfonamide in Native American children younger than 11 years of age. In subsequent controlled studies using various antimicrobial drugs (primarily aminopenicillins or sulfonamides) subjects receiving prophylaxis continued to have episodes of acute otitis media, but at rates substantially lower than those of controls. More recently, prophylaxis has appeared effective in reducing the number of acute recurrences, but not the cumulative proportion of time with middle ear effusion that was present independent of such recurrences. Although questions remain about choice of drug, optimal dosage schedules, risk of untoward drug reactions, duration of use, and the risk of encouraging the emergence of resistant strains of pathogenic bacteria, antimicrobial prophylaxis currently appears to be the most logical first approach in the management of the child with recurrent otitis media.