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Features predicting treatment failure in pediatric acute otitis media

Masamitsu Kono¹, Kunihiro Fukushima², Yosuke Kamide³

¹Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy

|August 24, 2020

Insights

Treatment failure in pediatric acute otitis media (AOM) was predicted by tympanic membrane and acute rhinosinusitis scores. These findings aid in discussing treatment decisions for AOM in children.

Area of Science:

Pediatric infectious diseases
Clinical pharmacology
Otolaryngology

Background:

Antibiotic stewardship is crucial for managing pediatric acute otitis media (AOM).
Identifying prognostic features of treatment failure can optimize antibiotic use.

Purpose of the Study:

To determine predictors of treatment failure in pediatric AOM.
To inform antibiotic stewardship strategies for AOM.

Main Methods:

A randomized, open-label trial enrolled children aged 1 month to 5 years with AOM.
Patients received amoxicillin alone or with clarithromycin.
Treatment success was evaluated using tympanic membrane scores and confirmed on day 14.

Main Results:

Treatment failure occurred in 19.4% of children.
Higher tympanic membrane and acute rhinosinusitis scores at days 3 and 5 predicted treatment failure.
Younger children (<2 years) had a higher failure rate.

Conclusions:

Tympanic membrane and acute rhinosinusitis scores on day 5 are significant predictors of AOM treatment failure.
These prognostic features can guide clinical decision-making and parental discussions regarding AOM treatment.

Read full analysis

Abstract

Objectives:

To facilitate better antibiotic stewardship, we conducted this clinical trial to identify the prognostic features of treatment failure in pediatric acute otitis media (AOM).

Study:

Design: This is a randomized, parallel-group, open-label, comparative clinical trial.

Subjects And Methods:

Children with AOM and aged between 1 month and 5 years were enrolled. Patients were randomly assigned to receive either amoxicillin alone (70 mg/kg) for five days, or the same with additional clarithromycin (15 mg/kg) for the initial three days. The clinical course of AOM was evaluated based on tympanic membrane scores. Failure of treatment for AOM was confirmed on day 14. Nasal conditions were also assessed by a clinical scoring system for acute rhinosinusitis.

Results:

Treatment failures occurred in 25 out of 129 (19.4%) children. The ratio of treatment failures by age was significantly higher in children younger than 2 years than in children older than 2 years. The tympanic membrane scores on day 3 (P = 0.0334) and day 5 (P < 0.0001) and acute rhinosinusitis scores on day 5 (P = 0.0004) were higher in failure cases than in cured cases. Multivariate logistic regression analysis indicated significant associations between the treatment failure with tympanic membrane scores and acute rhinosinusitis scores on day 5, and the antimicrobial treatment regimen.

Conclusions:

Improvement of acute rhinosinusitis and tympanic membrane scores on day five were important predictive features in failure of treatment for pediatric AOM. These results will be useful when discussing the treatment decisions with the patient's parents.

Keywords:

Acute otitis media Acute rhinosinusits Amoxicillin Prognosis Randomized clinical trial Tympanic membrane findings

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