Penicillin and acute otitis: short and long-term results

The effect of peroral penicillin V (55 mg/kg/day) on acute otitis media was investigated in 149 children between the ages of one and ten years in a double-blind, placebo-controlled investigation. The parameters of the disease employed were symptom scores for earache, the use of analgetics, otoscopy, as well as tympanometry. The children were followed up for three months. Penicillin had a significant effect on pain on the second day of treatment. The acute course of the disease was satisfactory in 69% of the children in the placebo group and in 86% in the penicillin group. In patients with pneumococci or hemolytic streptococci in the rhinopharynx, the pain already disappeared after one to two doses of penicillin, whereas the treatment had no effect on the patients with Haemophilus influenzae. There was no difference between the penicillin and placebo groups with regard to the results of otoscopy and tympanometry after one week, one month and three months. No serious complications were observed. It is concluded that an attitude of "masterful inactivity" with regard to the treatment of acute otitis media is justifiable, and in the majority of cases advisable, provided sufficient analgesic treatment is given and also that the patient can be closely followed. As there are still many unanswered questions more controlled investigations are warranted.