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Prophylaxis for recurrent acute otitis media: a Brazilian study
1Department of Otolaryngology, Faculdade de Medicina, Universidade de Sao Paulo, Brasil.
Insights
Antimicrobial prophylaxis significantly reduces recurrent acute otitis media (AOM) in children. Both trimethoprim-sulfamethoxazole and amoxicillin were equally effective, suggesting the less expensive option is preferable.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Recurrent acute otitis media (AOM) is a common childhood infection.
- Antimicrobial prophylaxis is a potential strategy to reduce AOM recurrence.
- Previous studies have shown mixed results on the efficacy of prophylaxis.
Purpose of the Study:
- To evaluate the effectiveness of antimicrobial prophylaxis in preventing recurrent AOM in children.
- To compare the efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) and amoxicillin (AMX) for AOM prophylaxis.
- To determine if prophylaxis influences the timing of AOM recurrence.
Main Methods:
- A randomized controlled trial involving 60 children with recurrent AOM.
- Children received either TMP-SMX, AMX, or placebo (PLA) once daily for 3 months at 1/3 therapeutic dose.
- Pneumootoscopy and impedance tympanometry (TYMP) were used for monthly evaluations and during acute illness.
Main Results:
- A significantly higher rate of recurrent AOM was observed in the placebo group (50%) compared to antibiotic groups (17%, P < 0.005).
- Both TMP-SMX (20% recurrence) and AMX (15% recurrence) were equally effective in preventing recurrent AOM.
- Recurrences in the placebo group occurred earlier than in the antibiotic prophylaxis groups.
Conclusions:
- Antimicrobial prophylaxis is effective in reducing the incidence of recurrent AOM in children.
- TMP-SMX and AMX demonstrate similar efficacy for preventing recurrent AOM.
- The findings support the use of antimicrobial prophylaxis, with cost-effectiveness favoring the less expensive agent.
Abstract:
We enrolled 60 children with recurrent acute otitis media (AOM) in a study of the effectiveness of antimicrobial prophylaxis. All children were entered into the study following an acute episode of infection treated with amoxicillin (AMX) for 10 days. Following therapy, the children were re-examined, and then randomly assigned to receive either trimethoprim-sulfamethoxazole (TMP-SMX), amoxicillin (AMX) or a placebo (PLA). Twenty children were included in each group. Each drug was administered once a day at bedtime, at 1/3 the therapeutic dose, for 3 months. Children were re-evaluated with pneumootoscopy during episodes of acute illness and with pneumootoscopy and impedance tympanometry (TYMP) at monthly intervals. We observed a significantly increased rate of recurrent AOM in children receiving placebo compared with those who received antibiotics (50% vs. 17% P < 0.005). Both prophylactic antibiotics were equally effective in preventing recurrent AOM (recurrence rate 20% TMP-SMX, 15% AMX). We also observed that recurrences in children receiving placebo occurred earlier in the study period than in those receiving antibiotics. These results suggest that antimicrobial prophylaxis in children with recurrent acute otitis media is effective in reducing subsequent disease. The similar efficacy of both antibiotics tested suggests that the less expensive agent should be used.
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