Sweet solution to acute otitis media? The sweetening substitute xylitol appears to be effective in the prevention of acute otitis media (AOM), report researchers from Finland.1 In this study, healthy children (mean age 2.2 years) who were not able to chew gum received syrup containing xylitol 0.5 g/day (controls; n = 165) or 10 g/day (xylitol group; 159). Children (mean age 4.6 years) who were able to chew gum received gum containing xylitol 0.5 g/day (controls; 178) or 8.4 g/day (xylitol group; 179) or lozenges containing xylitol 10 g/day (176). The treatments were given 5 times per day and the children were followed-up for 3 months.
Syrup and gum effective Significantly fewer children who received xylitol syrup experienced ≥ 1 episode of AOM, compared with recipients of control syrup [see table]. Similarly, significantly fewer xylitol gum, compared with control gum, recipients experienced ≥ 1 episode of AOM. While fewer children who received xylitol lozenges, compared with control gum, experienced ≥ 1 episode of AOM, the between-group difference was not statistically significant. In addition, both the rate and duration of antibacterial use was reduced in children who received xylitol, compared with controls.
Questions remain In an accompanying commentary, Dr Peter Wright from Vanderbilt Medical Center, Nashville, US, notes that ‘no single set of studies in an area as complex as otitis media is going to define the appropriate use of a novel intervention’ such as xylitol.2 He says that the critical question of whether or not xylitol would be as effective in children with recurrent otitis media remains unanswered. Furthermore, Dr Wright suggests that the 5-times-daily regimen used in this study may be ‘difficult to translate into a practical regimen’. Dr Wright concludes that while xylitol may have the potential to limit the impact of otitis media and antibacterial use, ‘the widespread introduction of a novel compound in high, frequent doses through early childhood cannot be taken lightly’. In another commentary, Dr Allen Mitchell from Boston University Schools of Medicine and Public Health, US, agrees that compliance with a 5-times-daily dosing regimen would be problematic and points out that the safety of xylitol in children also needs to be addressed.3 To help answer some of these outstanding questions, Dr Mitchell and colleagues are planning a large randomised US-based trial examining the use of xylitol in children aged 6–12 months. See also Inpharma 1064: 14, 23 Nov 1996; 800482514
Table. Outcomes of healthy children according to therapy Xylitol syrup recipients
Control syrup recipients
Xylitol gum recipients
Control gum recipients
Xylitol lozenge recipients
29*
41
16**
28
22
3.2 per 34.4 PYR*
4.33 per 37.7 PYR
1.66 per 42.1 PYR**
2.26 per 42.5 PYR
1.86 per 39.2 PYR
25 per 34.4 PYR*
31.7 per 37.7 PYR
11.8 per 42.1 PYR**
17.8 per 42.5 PYR
13.8 per 39.2 PYR**
Percentage of children experiencing ≥1 episode of AOM: Incidence of antibacterial prescriptions per person years at risk (PYR):
Number of days on antibacterials per PYR:
* signific- antly different compared with recip- ients of control syrup ** signific- antly different compared with recip- ients of control gum
1. Uhari M, et al. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics 102: 879-884, Part 1, Oct 1998. 2. Wright PF. Xylitol sugar and acute otitis media. Pediatrics 102: 971-972, Part 1, Oct 1998. 3. Mitchell AA. Xylitol prophylaxis for acute otitis media: tout de suite? Pediatrics 102: 974-975, Part 1, Oct 1998. 800632370
