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Trimethoprim-sulfamethoxazole treatment of persistent otitis media with effusion
Abstract:
Persistent otitis media with effusion (POME) is found in 50% of young children after 10 days of antimicrobial therapy for acute otitis media. Pathogenic bacteria are present in at least 25% of such effusions. We studied the effect of a 2-week course of trimethoprim-sulfamethoxazole (TMP-SMX) administered to 33 children who had POME and compared the results obtained to those of a similar group of children with POME who did not receive drug therapy. This study was designed to answer two questions: (1) Would TMP-SMX promote the resolution of POME? (2) Would TMP-SMX prevent an attack of acute otitis media (AOM) superimposed on POME? The diagnosis of POME was validated by obtaining a type B tympanogram, and AOM was diagnosed according to strict criteria. Each child was randomly assigned either to a treatment group that received a 14-day course of TMP-SMX or to a control group that received no medication. TMP-SMX failed to promote resolution of POME but did prevent recurrent AOM. During the second 2-week (follow-up) phase of the study, when no antimicrobial was given to either subject group, the incidence of AOM was similar in both groups.
Insights
Trimethoprim-sulfamethoxazole (TMP-SMX) did not resolve persistent otitis media with effusion in children. However, this antibiotic course effectively prevented recurrent acute otitis media (AOM) during treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Persistent otitis media with effusion (POME) affects 50% of young children post-antibiotic therapy for acute otitis media (AOM).
- Bacterial pathogens are identified in at least 25% of POME cases, necessitating further investigation into effective treatments.
Purpose of the Study:
- To determine if trimethoprim-sulfamethoxazole (TMP-SMX) promotes POME resolution.
- To assess TMP-SMX's efficacy in preventing superimposed acute otitis media (AOM) in children with POME.
Main Methods:
- A randomized controlled trial involving 33 children diagnosed with POME (confirmed by type B tympanogram).
- One group received a 14-day course of TMP-SMX, while the control group received no medication.
- Both groups were monitored for POME resolution and AOM incidence.
Main Results:
- TMP-SMX treatment did not significantly promote the resolution of POME.
- The TMP-SMX group showed a reduced incidence of recurrent AOM during the treatment period compared to the control group.
- Following the cessation of antimicrobial therapy, AOM incidence became similar in both groups.
Conclusions:
- TMP-SMX is not effective in resolving persistent otitis media with effusion in pediatric patients.
- TMP-SMX demonstrates prophylactic value against recurrent acute otitis media when administered for POME.