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Treatment of Acute Otitis Media in Young Children

  • OTITIS (DP SKONER, SECTION EDITOR)
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Abstract

Although acute otitis media (AOM) is one of the most common pediatric problems, the debate over treatment, especially in young children, continues. The 2004 Guideline on treatment of AOM stated that observation without antimicrobial therapy was an option for selected children 6−24 months of age with AOM. Two recent randomized trials sought to determine the necessity of antimicrobial treatment in young children; both studies found modest, statistically significant, positive effects of treatment. However, these studies provoked a flurry of discussion in the literature and the issue remains unsettled. That prevention is preferable to treatment is not controversial. Eliminating or modifying risk factors and use of vaccines, both bacterial and viral, may help decrease the number of AOM episodes. The discussion on treatment of AOM in young children must also take into account side effects of treatment and effect of treatment on possible long-lasting sequelae of AOM, such as developmental outcomes.

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References

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  1. Subcommittee on Management of AOM, American Academy of Pediatrics and American Academy of Family Physicians. Diagnosis and management of acute otitis media. Pediatrics. 2004;113(5):1451–65.

    Article  Google Scholar 

  2. Froom J, Culpepper L, Grob P, et al. Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network. Br Med J. 1990;300:582–6.

    Article  CAS  Google Scholar 

  3. •• Hoberman A, Paradise JL, Rockette HE, et al. Treatment of acute otitis media in children under 2 years of age. N Engl J Med. 2011;364(2):105–15. This is a placebo-controlled trial of amoxicillin-clavulanate for AOM in children 6-23 months of age.

    Article  PubMed  CAS  Google Scholar 

  4. •• Tähtinen PA, Laine MK, Huovinen P, et al. A placebo-controlled trial of antimicrobial treatment for acute otitis media. N Eng J Med. 2011;364:116–26. This is a placebo-controlled of amoxicillin-clavulanate for AOM in children 6-35 months of age.

    Article  Google Scholar 

  5. Burton M, Glasziou P. Children diagnosed with otitis media by an otoscopist benefited from antibiotics but suffered more side effects. Arch Dis Child Educ Pract Ed. 2012;97:38–9.

    Article  PubMed  Google Scholar 

  6. Crocco AG. Treatment of acute otitis media in children (comment). N Engl J Med. 2011;364(18):1777. author reply 1777-1778.

    PubMed  Google Scholar 

  7. Dachs R, Darby-Stewart A, Graber MA. Antibiotics for acute otitis media in young children: the case of the shifting end points. Am Fam Physician. 2012;85(2):104–5. 112.

    PubMed  Google Scholar 

  8. Damioseaux RA. Acute otitis media: do not change the Dutch practice guideline. Ned Tijdschr Geneeskd. 2012;156(10):A3795.

    Google Scholar 

  9. Darby-Stewart A, Graber MA, Dachs R. Antibiotics for acute otitis media in young children. Am Fam Physician. 2011;84(10):1095–7.

    PubMed  Google Scholar 

  10. Del Mar C, Glasziou P, Rovers M. Treatment of acute otitis media in children (comment). N Engl J Med. 2011;364(18):1776–7. author reply 1777-1778.

    PubMed  Google Scholar 

  11. Esposito S, Marchisio P, Tenconi R, Principi N. Antibiotic treatment of acute otitis media in pediatrics. Future Microbiol. 2011;6(5):485–8.

    Article  PubMed  Google Scholar 

  12. Grubb MS, Spaugh DC. Treatment of acute otitis media in children (comment). N Engl J Med. 2011;364(18):1776. author reply 1777-1778.

    PubMed  Google Scholar 

  13. Hoberman A, Paradise JL. In reference to : amoxicillin-clavulanate improves symptoms, reduces treatment failure in select children with acute otitis media and increases risk of diarrhoea. Evid Based Med 2012, doi:10.1136/ebmed-2011-100452. Accessed Sept 2012.

  14. Hoberman A, Paradise JL, Rockette HE. Author reply. N Eng J Med. 2011;364(18):1777–8.

    Google Scholar 

  15. Klein JO. Is acute otitis media a treatable disease? N Engl J Med. 2011;364(2):168–9.

    Article  PubMed  CAS  Google Scholar 

  16. Klein JO. Children under 2 years of age with acute otitis media benefit from antibiotic treatment. J Pediatr. 2011;159(3):514–5.

    Article  PubMed  Google Scholar 

  17. Marmor A, Newman TB. Amoxicillin-clavulanate improves symptoms, reduces treatment failure in select children with acute otitis media and increases risk of diarrhea. Evid Based Med. 2011;16(5):150–2.

    Article  PubMed  Google Scholar 

  18. Marmor A, Newman TB. Response to Drs Hoberman and Paradise. Evid Based Med 2012; doi:10.1136/ebmed-2012-100584. Accessed Sept 2012.

  19. Newman DH, Schriger DL. Trial registration and wandering outcomes. Ann Emerg Med. 2012;59(1):76–80.

    Article  PubMed  Google Scholar 

  20. Newman DH, Shreves AE. Treatment of acute otitis media in children (comment). N Engl J Med. 2011;364(18):1775. author reply 1777-1778.

    Article  PubMed  CAS  Google Scholar 

  21. Principi N, Esposito S, Marchisio P. Treatment of acute otitis media in children (comment). N Engl J Med. 2011;364(18):1777. author reply 1777-1778.

    PubMed  Google Scholar 

  22. Ruohola A, Tahtinen PA. Author reply. N Eng J Med. 2011;364(18):1778–9.

    Google Scholar 

  23. Spiro DM, Meckler GD, Arnold DH. Treatment of acute otitis media in children (comment). N Engl J Med. 2011;364(18):1775–6. author reply 1777-1779.

    Article  PubMed  Google Scholar 

  24. Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr. 1994;124(3):355–67.

    Article  PubMed  CAS  Google Scholar 

  25. • Sanders S, Glasziou PP, Del Mar CB, Rovers MM: Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2010; doi:10.1002/14651858.CD000219.pub2. Accessed Sept 2012. This is a meta-analysis of available trials to determine efficacy of antibiotics for AOM in children.

  26. Cohen R, Levy C, Bingen E, et al. Impact of 13-valent pneumococcal conjugate vaccine on pneumococcal nasopharyngeal carriage in children with acute otitis media. Pediatr Infect Dis J. 2012;31(3):297–301.

    Article  PubMed  Google Scholar 

  27. Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med. 2001;344(6):403–9.

    Article  PubMed  CAS  Google Scholar 

  28. Black S, Shinefield H, Fireman B, Northern California Kaiser Permanente Vaccine Study Center Group, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Pediatr Infect Dis J. 2000;19(3):187–95.

    Article  PubMed  CAS  Google Scholar 

  29. Heikkinen T, Chonmaitree T. Importance of respiratory viruses in acute otitis media. Clin Microbiol Rev. 2003;16(2):230–41.

    Article  PubMed  Google Scholar 

  30. Chonmaitree T, Ruohola A, Hendley JO. Presence of viral nucleic acids in the middle ear: acute otitis media pathogen or bystander? Pediatr Infect Dis J. 2012;31(4):325–30.

    Article  PubMed  Google Scholar 

  31. Pitkaranta A, Virolainen A, Jero J, et al. Detection of rhinovirus, respiratory syncytial virus, and coronavirus infections in acute otitis media by reverse transcriptase polymerase chain reaction. Pediatrics. 1998;102:291–5.

    Article  PubMed  CAS  Google Scholar 

  32. Winther B, Alper CM, Mandel EM, Doyle WJ, Hendley JO. Temporal relationships between colds, upper respiratory viruses detected by polymerase chain reaction and otitis media in young children followed through a typical sold season. Pediatrics. 2007;119(6):1069–75.

    Article  PubMed  Google Scholar 

  33. Alper CM, Winther B, Mandel EM, Hendley O, Doyle WJ. Rate of concurrent otitis media in upper respiratory tract infections with specific viruses. Arch Otolaryngol. 2009;135(1):17–21.

    Article  Google Scholar 

  34. Chonmaitree R, Revai K, Grady JJ, et al. Viral upper respiratory tract infection and otitis media complication in young children. Clin Infect Dis. 2008;46(6):815–23.

    Article  PubMed  Google Scholar 

  35. Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2011-2012. Pediatrics. 2011;128:813–25.

    Article  Google Scholar 

  36. Mandel EM, Doyle WJ, Winther B, Alper CM. The incidence, prevalence and burden of OM in unselected children aged 1 to 8 years followed by weekly otoscopy through the “common cold” season. Int J Pediatr Otorhinolaryngol. 2008;72:491–9.

    Article  PubMed  Google Scholar 

  37. Teele DW, Klein JO, Rosner B, Greater Boston Otitis Media Study Group. Epidemiology of otitis media during the first seven years of life in children in Greater Boston: a prospective, cohort study. J Infect Dis. 1989;160(1):83–94.

    Article  PubMed  CAS  Google Scholar 

  38. Paradise JL, Feldman HM, Campbell TF, et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356(3):248–61.

    Article  PubMed  CAS  Google Scholar 

  39. • Whitton JP, Polley DB. Evaluating the perceptual and pathophysiological consequences of auditory deprivation in early postnatal life: a comparison of basic and clinical studies. JARO. 2011;12:535–46. This review of the literature concerning developmental sequelae of otitis media raises concerns regarding conclusions based on data that did not include hearing status and proposes that the impact of hearing loss due to otitis media is greater than is appreciated.

    Article  PubMed  Google Scholar 

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Correspondence to Ellen M. Mandel.

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Mandel, E.M., Casselbrant, M.L. Treatment of Acute Otitis Media in Young Children. Curr Allergy Asthma Rep 12, 559–563 (2012). https://doi.org/10.1007/s11882-012-0309-9

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