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Antibiotic treatment of secretory otitis media
Abstract:
There is increasing evidence for an infectious etiology of secretory otitis media (SOM). Respiratory pathogens (S. pneumoniae, H. influenzae, B. catarrhalis and group A streptococci) have been found in cases of long-standing SOM, with a frequency of 18% in the middle ear and 79% in the nasopharynx. Erythromycin has been shown to penetrate into the middle ear effusion of SOM and into adenoid tissue. The concentrations surpassed the MIC's of most respiratory pathogens, with the exception of certain strains of H. influenzae. In agreement with this, a ten day course of erythromycin in children with SOM eradicated practically all nasopharyngeal strains of S. pneumoniae and B. catarrhalis, while there was no significant decrease in the number of strains of H. influenzae. The present study consisted of 119 children with SOM lasting three months or more. One group of 47 consecutive children was treated with erythromycin (Abboticin), given orally twice a day, in a dose of 40-60 mg/kg/24 hours, for ten days. The rate of resolution in this test group was 45% (21/47 cases). Another group of 72 consecutive children with SOM of a similar duration received no antibiotics. The cure rate in this control group was 15% (11/72 cases). The difference between the two groups is statistically significant (chi 2 = 11054; df = 1; p less than 0.001). The results suggest that a ten day course of erythromycin could reduce the need for surgical treatment in children with long-standing SOM.
Insights
Erythromycin treatment significantly improved secretory otitis media (SOM) resolution rates in children. A ten-day course of this antibiotic reduced the need for surgery in children with long-standing SOM.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Secretory otitis media (SOM) has increasing evidence of an infectious cause.
- Respiratory pathogens are frequently detected in middle ear fluid and nasopharynx of SOM patients.
- Erythromycin demonstrates penetration into middle ear effusion and adenoid tissue, with concentrations exceeding Minimum Inhibitory Concentrations (MICs) for many common pathogens.
Purpose of the Study:
- To evaluate the efficacy of erythromycin in treating secretory otitis media (SOM) in children.
- To determine if antibiotic therapy can reduce the need for surgical intervention in SOM cases.
- To assess the resolution rate of SOM following a ten-day course of erythromycin.
Main Methods:
- A study involving 119 children with SOM lasting three months or more.
- One group (n=47) received a ten-day oral course of erythromycin (40-60 mg/kg/24 hours).
- A control group (n=72) received no antibiotic treatment.
Main Results:
- The erythromycin treatment group showed a 45% resolution rate (21/47 cases).
- The control group had a 15% resolution rate (11/72 cases).
- The difference in resolution rates between the groups was statistically significant (p < 0.001).
Conclusions:
- A ten-day course of erythromycin is effective in treating secretory otitis media (SOM) in children.
- Erythromycin treatment significantly increases SOM resolution rates compared to no treatment.
- This antibiotic therapy may reduce the necessity for surgical procedures in children with chronic SOM.