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What are the risk factors for acute otitis media treatment failure?
Dan Michael Ron1, Sharon Ovnat Tamir2, Tal Marom2
1Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheba, Israel.
Insights
Recurrent ear infections, otorrhea, and perforated eardrums are key risk factors for acute otitis media treatment failure (AOMTF) in children. Early identification of these factors is crucial to prevent complications and reduce surgery referrals.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Acute otitis media (AOM) is a common childhood illness.
- Treatment failure (AOMTF) necessitates further medical intervention.
- Understanding risk factors is vital for effective management of AOMTF in vaccinated children.
Purpose of the Study:
- To identify risk factors for acute otitis media treatment failure (AOMTF).
- To analyze these factors in children immunized with the 13-valent pneumococcal conjugate vaccine (PCV).
Main Methods:
- Retrospective study of children under 12 years admitted between November 2017 and October 2020.
- Categorization into AOMTF (adequate pre-admission antibiotics) and AOM without treatment failure (AOMwTF) groups.
- Collection of demographic, clinical, laboratory, and hospitalization data.
Main Results:
- AOMTF occurred in 25% of AOM admissions.
- Risk factors for AOMTF included history of recurrent AOM (OR 7.6), otorrhea (OR 4), and tympanic membrane perforation (OR 3.6).
- AOMTF patients received more second- or third-line antibiotics (OR 4) and underwent more myringotomy/tube insertions (OR 2.3).
Conclusions:
- Early identification of risk factors like recurrent AOM, otorrhea, and TM perforation is essential.
- Proactive management can help reduce complication rates and surgical referrals for AOMTF.
Objective:
To identify risk factors associated with acute otitis media treatment failure (AOMTF) among 13-valent pneumococcal conjugate vaccine (PCV) immunized children.
Methods:
In this retrospective study, we identified children <12 years who were admitted to our hospital November 2017-October 2020. Children were categorized either as acute otitis media treatment failure (AOMTF), if they received adequate pre-admission antibiotics, or as AOM without treatment failure (AOMwTF), if they did not receive any pre-admission antibiotics. We collected demographics, clinical behavior, laboratory results, length and hospitalization course. Hospitalization was justified if previously treated properly.
Results:
The AOMTF group included 84 children (43 boys, mean age: 1.30 ± 0.83 years), whereas the AOMwTF group included 251 children (132 boys, mean age: 1.20 ± 0.89 years). AOMTF accounted for 25% of all AOM admissions. Among the AOMTF group, 46 (54.8%) were treated with amoxicillin and 24 (28.6%) with amoxicillin/clavulanic acid. Risk factors for AOMTF included recurrent AOM episodes history (30.9% vs 5.5%, OR 7.6, 95%CI 3.5-15.4, p < 0.001), otorrhea (29.4% vs 9.5%, OR 4, 95%CI 2.1-7.5, p < 0.001), tympanic membrane perforation (14.2% vs 4.3%, OR 3.6, 95%CI 1.5-8.6, p < 0.0019). Children with AOMTF were treated more with 2nd- or 3rd-line antibiotics (90.2% vs 65.9%, OR 4, 95%CI 2.2-10.4, p < 0.001), and underwent more myringotomy/ventilation tube insertions (14.4% vs 6.9%, OR 2.3, 95%CI 1.0-5.0, p = 0.037). Mean admission durations were similar: 3.83 ± 1.6 days in the AOMTF group vs 3.37 ± 2.77 days in the AOMwTF group (p = 0.15).
Conclusion:
Risk factors associated with AOMTF should be identified early during the AOM course to reduce complication rates and surgery referral.
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