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The effect of the leukotriene antagonist pranlukast on pediatric acute otitis media
Yoshihisa Nakamura1, Yuki Hamajima1, Motohiko Suzuki1
1Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Objective:
Conventional treatment for acute otitis media mainly targets bacteria with antibiotics, neglecting to control for mediators of inflammation. Mediators of inflammation, such as leukotrienes, have been identified in patients with acute otitis media (AOM) or subsequent secretory otitis media (SOM). They can cause functional eustachian tube dysfunction or increase mucous in the middle ear, causing persistent SOM following AOM. The objective of the present study was to evaluate whether or not administration of pranlukast, a widely used leukotriene C4, D4, and E4 antagonist, together with antibiotics could inhibit the progression to SOM.
Methods:
Children with AOM, who were from two to 12 years old, were randomly divided into two groups as follows: a control group in which 50 patients received antibiotic-based conventional treatment according to guidelines for treating AOM proposed by the Japan Otological Society (version 2006); and a pranlukast group, in which 52 patients were administered pranlukast for up to 28 days as well as given conventional treatment. Cases were regarded as persistent SOM when a tympanogram was type B or C2 four weeks after treatment was initiated.
Results:
Two patients in the pranlukast group and 3 patients in the control group were excluded because they relapsed AOM within 28 days after initial treatment. Therefore, the analysis included 50 and 47 subjects in the pranlukast and control groups, respectively. The percentage of patients diagnosed with persistent SOM (22.0%) was significantly smaller in the pranlukast group compared with the control group (44.7%) (p = 0.018, chi-squared test).
Conclusion:
The results indicate that combined treatment of AOM with antibiotics and a leukotriene antagonist to control inflammation is useful for preventing progression to persistent SOM.
Insights
Adding pranlukast, a leukotriene antagonist, to antibiotic treatment significantly reduced persistent secretory otitis media (SOM) in children with acute otitis media (AOM). This combined approach offers a promising strategy for preventing chronic ear conditions.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Pharmacology
Background:
- Acute otitis media (AOM) treatment primarily uses antibiotics, often overlooking inflammatory mediators like leukotrienes.
- Leukotrienes contribute to eustachian tube dysfunction and middle ear effusion, potentially leading to persistent secretory otitis media (SOM) after AOM.
Purpose of the Study:
- To investigate the efficacy of pranlukast, a leukotriene antagonist, combined with antibiotics in preventing the progression of AOM to persistent SOM.
- To evaluate the impact of anti-leukotriene therapy on middle ear inflammation and effusion in pediatric patients.
Main Methods:
- A randomized controlled trial involving 102 children aged 2 to 12 years with AOM.
- The control group received standard antibiotic treatment, while the pranlukast group received antibiotics plus pranlukast for up to 28 days.
- Persistent SOM was defined as tympanogram types B or C2 four weeks post-treatment initiation.
Main Results:
- The analysis included 50 patients in the pranlukast group and 47 in the control group.
- Persistent SOM was observed in 22.0% of patients in the pranlukast group, significantly lower than the 44.7% in the control group (p=0.018).
Conclusions:
- Combined antibiotic and pranlukast therapy is effective in preventing the progression from AOM to persistent SOM.
- Targeting leukotriene-mediated inflammation alongside antibiotics offers a beneficial strategy for managing pediatric ear infections and preventing chronic sequelae.
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