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Treatment of recurrent otitis media after a previous treatment failure. Which antibiotics work best?
W J Hueston1, S Ornstein, R G Jenkins
1Department of Family Medicine, Medical University of South Carolina, Charleston 29425-0100, USA. huestowj@musc.edu
Background:
Recurrent infection after an episode of otitis media is common in pediatric patients. If a patient experienced primary treatment failure in a preceding episode, physicians often feel pressured to prescribe a broad-spectrum, second-line agent for the next episode rather than a first-line drug. The purpose of our study was to determine whether using a second-line drug resulted in fewer treatment failures in a recurrent otitis episode following an episode of apparent resistance.
Methods:
The Practice Partner Research Network database, a national research network of practices that use the same electronic medical record, was reviewed to identify all primary episodes of otitis media over a 2-year period (N = 7807). From this, 1416 pediatric patients with presumed treatment failures were identified. The subset of those with a second otitis media episode more than 90 days after the index episode (N = 343) was selected for study. Of this group, 236 (69%) received first-line antibiotics (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) and the remaining 107 received a broader-spectrum, second-line antibiotic. The primary outcome was the need for an additional antibiotic for otitis media within the next 45 days.
Results:
Patients receiving first- and second-line antibiotics did not differ in sex or age. However, those receiving second-line antibiotics had a shorter duration between episodes (231 vs 280 days, P = .007). Failure rates for first- and second-line antibiotics in recurrent episodes were not significantly different (13% vs 19%, P = .20). Because the duration between episodes could have affected failure rates, we stratified the time between episodes into short, intermediate, and long duration. Second-line antibiotics were not superior to first-line drugs in any stratum.
Conclusions:
For a new otitis media episode in a patient with a previous treatment failure, first-line drugs (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) are just as effective as broader-spectrum, more expensive, second-line antibiotics.
Insights
For recurrent ear infections in children, first-line antibiotics are as effective as second-line drugs after a previous treatment failure. This finding challenges the common practice of using broader-spectrum antibiotics in such cases.
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
- Clinical research methodology
Background:
- Recurrent otitis media is common in children, often leading to physician pressure to use second-line antibiotics after initial treatment failure.
- This study addresses the clinical dilemma of selecting antibiotic therapy for recurrent otitis media following a presumed resistant episode.
Purpose of the Study:
- To determine if second-line antibiotics reduce treatment failures in recurrent otitis media episodes after a prior treatment failure.
- To compare the efficacy of first-line versus second-line antibiotic agents in pediatric patients with recurrent otitis media.
Main Methods:
- Retrospective analysis of electronic medical records from the Practice Partner Research Network database (N=7807).
- Identified 343 pediatric patients with a second otitis media episode >90 days after initial treatment failure.
- Compared treatment failure rates (need for additional antibiotic within 45 days) between patients receiving first-line (n=236) and second-line (n=107) antibiotics.
Main Results:
- No significant difference in failure rates between first-line (13%) and second-line (19%) antibiotics in recurrent otitis media episodes (P=.20).
- Patients receiving second-line antibiotics had a shorter interval between episodes (231 vs 280 days, P=.007).
- Second-line antibiotics did not demonstrate superiority over first-line drugs across different time intervals between episodes.
Conclusions:
- First-line antibiotics are equally effective as broader-spectrum, second-line agents for recurrent otitis media following a previous treatment failure.
- This suggests that first-line antibiotic therapy can be considered a viable option in such clinical scenarios, potentially avoiding unnecessary use of more expensive, broad-spectrum drugs.