Antibacterials are effective in otitis media Although failure is more likely in children aged < 18 months ...
'Our data show that clinical improvement is associated with elimination of bacteria from the middle ear and thus support the use of antibiotic therapy for acute otitis media.' This conclusion was reached
~fter a retrospective evaluation of 518 children enrolled in randomised double-blind studies investigating the treatment of acute otitis media. The children were aged ~ 12 years, were treated as outpatients from 1979-1988, and the majority received antibacterials which inhibited or were stable to beta lactamase. Eradication of the pathogen after 3-6 days' therapy occurred in 86% of 293 evaluable children, and symptoms had resolved in 93% of the bacteriological responders. Clinical improvement was common despite persistence of bacteria, and 62% of children with bacteriological failure were clinically improved. Additionally, 53% of those with clinical failure had sterile cultures. It was notable that all the treatment failures except for 1 were aged < 18 months and Black children had a higher rate of failure. The causative pathogens were stable throughout the study period, except for the appearance of beta lactamase-positive Moraxella catarrhalis. Carlin SA, Marchant CD, Shurin PA, Johnson CE, Super OM, et al. Host factors and early therapeutic response in acute otitis media. Journal of Pediatrics 118: 178·183, Feb 1991 5806
... and the addition of steroids improves response in the presence of effusion
'... We believe that our proposed combined treatment of steroids and antibiotics deserves its place as a routine conservative trial before surgery.'
The authors studied 136 untreated children aged 4-10 years with persistent otitis media with effusion, specifically excluding children with hypertrophic adenoids. 50 children received 14 days' therapy with amoxicillin 50 mg/kg + tapered prednisone 1 mg/kg. Of these, 40 and 40% experienced complete improvement in the air-bone gap and tympanometry, respectively, and partial improvement occurred in 50 and 40% of children. This response was significantly better than the complete improvement of 40 and 30%, and the partial improvement of 20 and 10% in the air-bone gap and tympanometry of 49 children receiving amoxicillin alone. Both active treatments were significantly superior to placebo (n = 30).
Podoshin L, Fradis M, Ben·David Y, Faraggi D. The efficacy of oral steroids in the treatment of persistent otitis media with effusion. Archives of Otolaryngology· Head and Neck Surgery 116: 1404-1406, Dec 1990 580S
ISSN 0156-2703/91/0316.0013/0$01.00/0
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INPHARMA®16 Mar 1991
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