Skip to main content

Advertisement

SpringerLink
Log in

Antibiotic theory in otitis media

  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Otitis media is currently the most common diagnosis made by clinicians, which has a major impact on managed care. The emergence of resistant bacterial pathogens has caused controversy over the use of antibiotics when acute otitis media (AOM) is diagnosed. All infants with AOM and all older children with severe AOM should be treated with antibiotics, despite concerns about rising rates of resistant bacterial pathogens. Some older children with nonsevere AOM may be candidates for initial observation, although this is not confirmed by clinical trials. Antimicrobial agents are not required for otitis media with effusion of recent onset but may be considered if this effusion becomes chronic; in these cases, tympanostomy tube placement may be indicated. Antimicrobial prophylaxis for prevention of recurrent AOM should be reserved for selected patients because of the possible emergence of resistant organisms. Tympanostomy tube placement is a more reasonable option today.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Teele DW, Klein JO, Rosner B, et al.: Middle ear disease and the practice of pediatrics: burden during the first five years of life. JAMA 1983, 249:1026–1029.

    Article  PubMed  CAS  Google Scholar 

  2. Schappert SM: Office visits for otitis media: United States, 1975–90. Hyattsville: Centers for Disease Control and Prevention/National Center for Health Statistics; 1992. [Vital and Health Statistics 214:1-18.]

    Google Scholar 

  3. Ruuskaneen O, Arola M, Putto-Laurila A, et al.: Acute otitis media in respiratory virus infections. Pediatr Infect Dis J 1989, 8:94–99.

    Google Scholar 

  4. Moyse E, Lyon M, Cordier G, et al.: Viral RNA in middle ear mucosa and exudates in patients with chronic otitis media with effusion. Arch Otolaryngol Head Neck Surg 2000, 126:1105–1110.

    PubMed  CAS  Google Scholar 

  5. Klein JO: Otitis media. Clin Infect Dis 1994, 19:823–833.

    PubMed  CAS  Google Scholar 

  6. Suzuki K, Bakaletz LO: Synergistic effect of adenovirus type 1 and nontypable Haemophilus influenzae in a chinchilla model of experimental otitis media. Infect Immun 1994, 62:1710–1718.

    PubMed  CAS  Google Scholar 

  7. Giebink GS: Studies of Streptococcus pneumoniae and influenza virus vaccines in the chinchilla otitis media model. J Infect Dis 1989, 8:S42-S44.

    Article  CAS  Google Scholar 

  8. Sung BS, Chonmaitree T, Broemeling LD, et al.: Association of rhinovirus infection with poor bacteriologic outcome of bacterial viral otitis media. Clin Infect Dis 1993, 17:38–42.

    PubMed  CAS  Google Scholar 

  9. Kaleida PH, Casselbrant ML, Rockette HE, et al.: Amoxicillin or myringotomy or both for acute otitis media: results of a randomized clinical trial. Pediatrics 1991, 87:466–474.

    PubMed  CAS  Google Scholar 

  10. Arola M, Ruuskanen O, Ziegler T, et al.: Clinical role of respiratory virus infection in acute otitis media. Pediatrics 1990, 86:848–855.

    PubMed  CAS  Google Scholar 

  11. van Buchem FL, Dunk JH, van’t Hof MA: Therapy of acute otitis media: myringotomy, antibiotics or neither? A doubleblind study in children. Lancet 1981, 2:883–887.

    PubMed  Google Scholar 

  12. Culpepper L, Froom J: Routine antimicrobial treatment of acute otitis media: is it necessary? JAMA 1997, 278:1643–1645.

    Article  PubMed  CAS  Google Scholar 

  13. Dowell SF, Marcy SM, Phillips WR, et al.: Otitis media— principles of judicious use of antimicrobial agents. Pediatrics 1998, 101(suppl):165–171. This article provides important clinical guidelines for the practitioner and a position statement.

    Google Scholar 

  14. Rosenfeld JM, 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, 124:355–367.

    Article  PubMed  CAS  Google Scholar 

  15. Del Mar C, Glasziou P, Hayem M: Are antibiotics indicated as initial treatment for children with acute otitis media? A meta analysis. BMJ 1997, 314:1526–1529.

    Google Scholar 

  16. Glasziou PP, Hayem M, Del Mar CB: Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2000, 1(2):CD000219.

    Google Scholar 

  17. Damoiseaux RAMJ, Van Balen FAM, Hoes AW, et al.: Primary care based randomized double-blind trial of amoxicillin vs. placebo for acute otitis media in children aged under two years. BMJ 2000, 320:350–354.

    Article  PubMed  CAS  Google Scholar 

  18. Howie VM, Pollard RB, Kleyn K, et al.: Presence of interferon during bacterial otitis media. J Infect Dis 1982, 145:811–814.

    PubMed  CAS  Google Scholar 

  19. Lahikainen EA: Clinico-bacteriologic studies on acute otitis media: aspiration of tympanum as diagnostic and therapeutic method. Acta Otolaryngol (Stockh) 1953, 107:1–82.

    Google Scholar 

  20. Bluestone CD Klein J: Otitis Media in Infants and Children, edn 3. Philadelphia: WB Saunders, 2001.

    Google Scholar 

  21. Post JC, Preston RA, Aul JJ, et al.: Molecular analysis of bacterial pathogens in otitis media with effusion. JAMA 1995, 273:1598–1604.

    Article  PubMed  CAS  Google Scholar 

  22. Rayner MG, Zhang Y, Gorry MC, et al.: Evidence of bacterial metabolic activity in culture-negative otitis media with effusion. JAMA 1998, 279:296–299. This is an important contribution to our understanding of the microbial pathogenesis of OM.

    Article  PubMed  CAS  Google Scholar 

  23. Harabuchi Y, Faden H, Yamanaka N, et al.: Nasopharyngeal colonization with nontypable Haemophilus influenzae and recurrent otitis media. J Infect Dis 1994, 170:862–866.

    PubMed  CAS  Google Scholar 

  24. Faden H, Duffy L, Williams A, et al.: Epidemiology of nasopharyngeal colonization with non-typable Haemophilus influenza in the first two years of life. J Infect Dis 1995, 172:132–135.

    PubMed  CAS  Google Scholar 

  25. Smith-Vaughan HC, Kemp DJ, Leach AJ, et al.: Carriage of non-typable Haemophilus influenzae in Aboriginal infants with otitis media. In Proceedings of the 6th International Symposium on Recent Advances in Otitis Media. Edited by Lim DJ, Bluestone CD, Casselbrant MC, et al. Hamilton: BC Decker; 1996:288–290.

    Google Scholar 

  26. Jorgensen F, Andersson B, Larsson SH, et al.: Children with frequent attacks of acute otitis media: a re-examination after eight years concerning middle ear changes, hearing, tubal function, and bacterial adhesion to pharyngeal epithelial cells. In Recent Advances in Otitis Media with Effusion. Edited by Lim DJ, Bluestone CD, Klein JO, Nelson JD. Hamilton: BC Decker; 1984:141–144.

    Google Scholar 

  27. St Geme JW III, Falkow S, Barenkamp SJ: High-molecular weight proteins of nontypable Haemophilus influenzae mediate attachment to human epithelial cells. Proc Natl Acad Sci U S A 1993, 90:2875–2879.

    Article  Google Scholar 

  28. Costerton JW, Lewandowski Z, Caldwell DE, et al.: Microbial biofilms. Ann Rev Microbiol 1995, 49:711–745.

    Article  CAS  Google Scholar 

  29. DeMaria TF, Briggs BR, Okazoki N, Lim DJ: Experimental otitis media with effusion following middle ear inoculation of non-viable Haemophilus influenzae. Ann Otol Rhinol Laryngol 1984, 93:52–56.

    PubMed  CAS  Google Scholar 

  30. Nell MJ, Grote JJ: Endotoxin and tumor necrosis factor-alpha in MEEs in relation to upper airway infection. Laryngoscope 1999, 109:1815–1819.

    Article  PubMed  CAS  Google Scholar 

  31. LaMarco KL, Diven WF, Glew RH, et al.: Neuraminidase activity in middle ear effusion. Ann Otol Rhinol Laryngol 1984, 93:76–84.

    PubMed  CAS  Google Scholar 

  32. Virolainen A, Jero J, Chattopadhyay, et al.: Comparison of serum antibodies to pneumolysin with those to pneumococcal capsular polysaccharides in children with acute otitis media. Pediatr Infect Dis J 1996, 15:128–133.

    Article  PubMed  CAS  Google Scholar 

  33. Dagan R, Givon N, Yagupsky P, et al.: Effect of a 9-valent pneumococcal vaccine conjugated to CRM 197 on nasopharyngeal carriage of vaccine type and nonvaccine type S. pneumoniae strains among day-care center attendees. Abstract presented at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy. September 1998. San Diego.

  34. Berman S, Byrns PJ, Bondy J, et al.: Otitis media-related antibiotic prescribing patterns, outcomes and expenditures in a pediatric Medicaid population. Pediatrics 1997, 100:585–592.

    Article  PubMed  CAS  Google Scholar 

  35. Paradise JL: Short-course antimicrobial treatment for acute otitis media: not best for infants and young children. JAMA 1997, 278:1640–1642.

    Article  PubMed  CAS  Google Scholar 

  36. Casselbrant ML, Kaleida PH, Rockette HE, et al.: Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial. Pediatr Infect Dis J 1992, 11:278–286.

    Article  PubMed  CAS  Google Scholar 

  37. Harrison CJ: Using antibiotic concentrations in middle ear fluid to predict potential clinical efficacy. Pediatr Infect Dis J 1997, 16:S12-S16.

    Article  PubMed  CAS  Google Scholar 

  38. Mandel EM, Rockette HE, Bluestone CD, et al.: Efficacy of myringotomy with and without tympanostomy tubes for chronic otitis media with effusion. Pediatr Infect Dis J 1992, J11:270–277.

    Google Scholar 

  39. Giebink GS: Risk of mastoiditis in typical otitis media not managed by antibiotics. Lancet 1982, 1:117.

    Google Scholar 

  40. Sorenson H: Antibiotics in suppurative otitis media. Otolaryngol Clin North Am 1977, 10:45–50.

    Google Scholar 

  41. Goldstein NA, Casselbrant ML, Bluestone CD, Kurs-Lasky M: Intratemporal complications of acute otitis media in infants and children. Otolaryngol Head Neck Surg 1998, 119:444–454. This is a good review and analysis of complications.

    Article  PubMed  CAS  Google Scholar 

  42. Fria TJ, Cantekin EI, Eichler JA: Hearing acuity of children with otitis media with effusion. Arch Otolaryngol Head Neck Surg 1985, 111:10–16.

    CAS  Google Scholar 

  43. Paradise JL: Does early-life otitis media result in lasting developmental impairment? Why the question persists, and a proposed plan for addressing it. Adv Pediatr 1992, 39:157–165.

    PubMed  CAS  Google Scholar 

  44. Lundman L, Juhn SK, Bagger-Sjoback D, Svanborg C: Permeability of the normal round window membrane to Haemophilus influenzae type b endotoxin. Acta Otolaryngol 1992, 112:524–529.

    PubMed  CAS  Google Scholar 

  45. Kafka MM: Mortality of mastoiditis and cerebral complications with review of 3225 cases of mastoiditis with complications. Laryngoscope 1935, 45:790–822.

    Google Scholar 

  46. Lund WS: A review of 50 cases of intracranial complications from otogenic infection between 1961 and 1977. Clin Otolaryngol 1978, 3:494–501.

    Google Scholar 

  47. Friedman EM, McGill TJI, Healy GB: Central nervous system complications associated with acute otitis media in children. Laryngoscope 1990, 100:149–151.

    PubMed  CAS  Google Scholar 

  48. Albers FWJ: Complications of otitis media: the importance of early recognition. Am J Otol 1999, 20:9–12.

    PubMed  CAS  Google Scholar 

  49. Kraus M, Tovi F: Central nervous system complications secondary to oto-rhinologic infections: an analysis of 39 pediatric cases. Int J Pediatr Otorhinolaryngol 1992, 24:217–226.

    Article  PubMed  CAS  Google Scholar 

  50. Kangsanarak J, Fooanant S, Ruckphaopunt K, et al.: Extracranial and intracranial complications of suppurative otitis media: report of 102 cases. J Laryngol Otol 1993, 107:999–1004.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Otolaryngology, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, 15213, Pittsburgh, PA, USA

    Anil Gungor MD & Charles D. Bluestone MD

Authors
  1. Anil Gungor MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles D. Bluestone MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gungor, A., Bluestone, C.D. Antibiotic theory in otitis media. Curr Allergy Asthma Rep 1, 364–372 (2001). https://doi.org/10.1007/s11882-001-0050-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-001-0050-2

Keywords

Search

Navigation