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Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial
M Uhari1, T Kontiokari, M Koskela
1Department of Paediatrics, University of Oulu, Finland.
Insights
Xylitol chewing gum significantly reduced acute otitis media incidence in children. This preventive effect suggests xylitol
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Pharmacology
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Streptococcus pneumoniae is a key pathogen in AOM.
- Xylitol has demonstrated inhibitory effects on S. pneumoniae growth.
Purpose of the Study:
- To investigate the clinical efficacy of xylitol in preventing AOM.
- To assess the impact of xylitol on AOM recurrence and antimicrobial use.
Main Methods:
- A double-blind, randomized controlled trial was conducted.
- 306 children in daycare received either xylitol or sucrose chewing gum for two months.
- Outcomes included AOM occurrence, antimicrobial prescriptions, and S. pneumoniae nasopharyngeal carriage.
Main Results:
- Xylitol gum reduced AOM incidence by 8.7% compared to sucrose (P=0.04).
- Fewer antimicrobials were prescribed for AOM in the xylitol group (18.5% vs 28.9%, P=0.032).
- No significant difference in S. pneumoniae carriage rates was observed between groups.
Conclusions:
- Xylitol chewing gum demonstrates a preventive effect against acute otitis media.
- Xylitol may be a valuable adjunct in managing and preventing AOM in children.
Objective:
To examine whether xylitol, which reduces the growth of Streptococcus pneumoniae, might have clinical importance in the prevention of acute otitis media.
Design:
A double blind randomised trial with xylitol administered in chewing gum.
Setting:
Eleven day care nurseries in the city of Oulu. Most of the children had had problems with recurrent acute otitis media.
Subjects:
306 day care children: 149 children in the sucrose group (76 boys; mean (SD) age 4.9 (1.5) years) and 157 in the xylitol group (80 boys; 5.0 (1.4) years).
Intervention:
Either xylitol (8.4 g a day) or sucrose (control) chewing gum for two months.
Main Outcome Measures:
The occurrence of acute otitis media and antimicrobial treatment received during the intervention and nasopharyngeal carriage of S pneumoniae.
Results:
During the two month monitoring period at least one event of acute otitis media was experienced by 31/149 (20.8%) children who received sucrose compared with 19/157 (12.1%) of those receiving chewing gum containing xylitol (difference 8.7%; 95% confidence interval 0.4% to 17.0%; P = 0.04). Significantly fewer antimicrobials were prescribed among those receiving xylitol: 29/157 (18.5%) children had at least one period of treatment versus 43/149 (28.9%) (difference 10.4%; 0.9% to 19.9%; P = 0.032). The carriage rate of S pneumoniae varied from 17.4% to 28.2% with no difference between the groups. Two children in the xylitol group experienced diarrhoea, but no other adverse effects were noted among the xylitol users.
Conclusion:
Xylitol seems to have a preventive effect against acute otitis media.