Antimicrobial Treatment of Acute Otitis Media Shortens Duration of Middle Ear Effusion

By Will Boggs MD

NEW YORK - Antimicrobial treatment accelerates the resolution of middle ear effusion associated with acute otitis media, researchers from Finland report.

"Our results imply that the children with acute otitis media are likely to benefit from antimicrobial treatment regardless of their age," Dr. Terhi Tapiainen from University of Oulu told Reuters Health by email. "Some experts have suggested that only infants should be treated, but it appears that the duration of possible hearing impairment and the risk of persistent middle ear effusion decreases in all children."

"However, clinicians should try to restrict the antimicrobial treatment to children with acute otitis media, i.e., children who have both acute respiratory symptoms and signs of inflammation of tympanic membrane and middle ear effusion at the same time," Dr. Tapiainen said.

Dr. Tapiainen and colleagues sought to clarify whether antimicrobial treatment of acute otitis media reduces the duration of middle ear effusion and concomitant hearing impairment in a randomized, placebo-controlled trial of 84 children between 6 months and 15 years of age.

Middle ear effusion resolved an average of 2.0 weeks earlier in the 42 children who received antimicrobial therapy (mean, 18.9 days) than in the 42 children not treated with antibiotics (mean, 32.6 days), according to the May 5 JAMA Pediatrics online report.

Mean duration of middle ear effusion was decreased by 8 days in children younger than 2 years, by 20 days in children aged 2 to 6 years, and by 1 day among older children.

To prevent persistent middle ear effusion at day 14 in one child required treatment of 3.2 children with antimicrobials. Similarly, to prevent persistent middle ear effusion at 2 months in one child required treatment of 5.3 children with antimicrobials.

Antimicrobial treatment also reduced the number of days of ear pain by about 1 day, researchers say.

Five children (12%) treated with amoxicillin-clavulanate developed diarrhea in the first 10 days, compared with no children in the placebo group, and more children in the antimicrobial group (four, 9.5%) than in the placebo group (two, 4.8%) experienced vomiting within 10 days of study entry. None of the children in either group had a rash or oral thrush during treatment.

"We certainly were surprised about the magnitude of the effect since our result was contrary to that seen in many earlier trials," Dr. Tapiainen said. "We did expect to get unique data from our trial since the daily follow up of middle ear status has usually not been done in earlier studies. Yet, the effect size was greater than we expected."

"Diagnosis of acute otitis media is challenging and requires training and patience," Dr. Tapiainen said. "The use of tympanometry together with pneumatic otoscopy might help in the diagnosis in clinical practice and might help in restricting the antimicrobial treatment to those children with probable acute otitis media. We should aim to reduce our antimicrobial consumption by improving our diagnostic skills and not by restricting antimicrobials from children with carefully diagnosed acute otitis media."

Dr. Matija Daniel from The University of Nottingham in the UK has also studied treatments for middle ear effusion. He told Reuters Health by email, "It is interesting to see that antibiotics reduced middle ear effusion duration, but I would want to see how this translates to hearing level and parent-reported problems before any change in practice is contemplated. Much research has been done on acute otitis media and antibiotics, with clear guidelines in place based on the multitude of studies out there."

SOURCE: https://bit.ly/1srche1

JAMA Pediatr 2014.

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