Related Experiment Video
Updated: May 4, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Xylitol syrup for the prevention of acute otitis media
Louis Vernacchio1, Michael J Corwin, Richard M Vezina
1Pediatric Physician's Organization at Children's, Brookline, Massachusetts;
Insights
This study found that viscous xylitol solution, taken three times daily, did not effectively reduce acute otitis media (AOM) in young children prone to ear infections. Further research is needed for convenient AOM prevention strategies.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Acute otitis media (AOM) is a prevalent childhood illness and a primary reason for antibiotic prescriptions in the US.
- Xylitol has shown potential in reducing AOM with frequent dosing, but a more convenient regimen is desirable.
Purpose of the Study:
- To evaluate the efficacy of a viscous xylitol solution (5 g, 3 times daily) in preventing clinically diagnosed AOM in children aged 6 months to 5 years.
- To assess if a less frequent xylitol dosing schedule could be a viable option for AOM prevention.
Main Methods:
- A pragmatic, practice-based randomized controlled trial was conducted.
- 326 otitis-prone children were randomized to receive either viscous xylitol solution or a placebo, 3 times per day.
- The primary outcome was the time to the first clinically diagnosed AOM episode.
Main Results:
- The hazard ratio for xylitol versus placebo was 0.88 (95% CI 0.61 to 1.3), indicating no significant reduction in AOM.
- Secondary analyses showed no significant difference in AOM incidence or antibiotic use between groups.
- Nonadherence did not explain the lack of effectiveness.
Conclusions:
- Viscous xylitol solution at 5 g three times daily was ineffective in reducing AOM in otitis-prone children.
- The tested xylitol regimen is not a viable strategy for preventing AOM in this population.
- Alternative, more convenient AOM prevention methods require investigation.
Background:
Acute otitis media (AOM) is a common childhood illness and the leading indication for antibiotic prescriptions for US children. Xylitol, a naturally occurring sugar alcohol, can reduce AOM when given 5 times per day as a gum or syrup, but a more convenient dosing regimen is needed for widespread adoption.
Methods:
We designed a pragmatic practice-based randomized controlled trial to determine if viscous xylitol solution at a dose of 5 g 3 times per day could reduce the occurrence of clinically diagnosed AOM among otitis-prone children 6 months through 5 years of age.
Results:
A total of 326 subjects were enrolled, with 160 allocated to xylitol and 166 to placebo. In the primary analysis of time to first clinically diagnosed AOM episode, the hazard ratio for xylitol versus placebo recipients was 0.88 (95% confidence interval [CI] 0.61 to 1.3). In secondary analyses, the incidence of AOM was 0.53 episodes per 90 days in the xylitol group versus 0.59 in the placebo group (difference 0.06; 95% CI -0.25 to 0.13); total antibiotic use was 6.8 days per 90 days in the xylitol group versus 6.4 in the placebo group (difference 0.4; 95% CI -1.8 to 2.7). The lack of effectiveness was not explained by nonadherence to treatment, as the hazard ratio for those taking nearly all assigned xylitol compared with those taking none was 0.93 (95% CI 0.56 to 1.57).
Conclusions:
Viscous xylitol solution in a dose of 5 g 3 times per day was ineffective in reducing clinically diagnosed AOM among otitis-prone children.
Related Concept Videos
01:26Tonsillitis II: Management
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:14Prevention of Further Absorption of Poison