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Treatment and outcome of severe and non-severe acute otitis media.
Eur J Pediatr 2005; 164(1):3-8EJ

Abstract

To determine outcomes in acute otitis media (AOM) according to severity of disease and to assess different initial treatment regimens, 308 with AOM were enrolled and divided into severe (n = 277; 89.9%) and non-severe (n = 31; 10.1%) groups based on symptoms and tympanic membrane changes. Children in the severe group were initially managed with amoxicillin (AMPC) whereas children in the non-severe group were initially managed without antibiotics. Children were monitored on days 1, 5, 10, 14 and 28. Five outcome measures were assessed: disappearance of symptoms at day 5, resolution of tympanic membrane changes by day 28, disappearance of middle ear effusions by day 28, recurrence of acute symptoms prior to day 28, and need to change treatment regimens. Children with severe disease were more often male (57% versus 36%, P < 0.05) and more often colonized with pathogens (77% versus 55%, P < 0.05 than children with non-severe disease. The two groups were similar with respect to age and day care attendance. Despite differences in initial treatment regimens between the two groups, symptoms improved at the same rate for severe and non-severe disease, 94% by day 5. In contrast, tympanic membranes returned to normal in 69% of the severe and 81% of the non-severe groups by day 28; however, as early as day 5, 10% of the severe and 55% of the non-severe groups demonstrated normal tympanic membranes. Middle ear effusions similarly disappeared more slowly in the severe group, 52% versus 74% by day 14 and 76% versus 84% by day 28. Recurrence rates of acute symptoms occurred with equal frequency in the severe, 15%, and non-severe groups, 10%. Failure of the symptoms or the tympanic membranes to improve led to antibiotic changes in 59.9% of the severe group and to the addition of antibiotics in 51.6% of the non-severe group. Children in the severe group who failed to improve with an initial course of amoxicillin were younger (40.2 months versus 45.8 months, P < 0.05), had higher tympanic membrane scores (4.5 versus 4.1, P < 0.05), and were more often colonized with penicillin-resistant Streptococcus pneumoniae (33.8% versus 6.5%, P < 0.01) than children who responded to AMPC. In a similar manner, children with non-severe disease who failed to improve without antibiotics were younger (40.7 months versus 54.8 months, P < 0.05) and more often colonized with pathogens (75.0% versus 33.4%, P < 0.05).

CONCLUSION

Severe disease occurred more often among males and among children colonized with pathogens. Response to treatment was impaired in younger children and in children colonized with pathogens, especially penicillin-resistant Streptococcus pneumoniae.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15549378

Citation

Hotomi, Muneki, et al. "Treatment and Outcome of Severe and Non-severe Acute Otitis Media." European Journal of Pediatrics, vol. 164, no. 1, 2005, pp. 3-8.
Hotomi M, Yamanaka N, Samukawa T, et al. Treatment and outcome of severe and non-severe acute otitis media. Eur J Pediatr. 2005;164(1):3-8.
Hotomi, M., Yamanaka, N., Samukawa, T., Suzumot, M., Sakai, A., Shimada, J., ... Faden, H. (2005). Treatment and outcome of severe and non-severe acute otitis media. European Journal of Pediatrics, 164(1), pp. 3-8.
Hotomi M, et al. Treatment and Outcome of Severe and Non-severe Acute Otitis Media. Eur J Pediatr. 2005;164(1):3-8. PubMed PMID: 15549378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment and outcome of severe and non-severe acute otitis media. AU - Hotomi,Muneki, AU - Yamanaka,Noboru, AU - Samukawa,Takao, AU - Suzumot,Masaki, AU - Sakai,Akihiro, AU - Shimada,Jun, AU - Ikeda,Yorihiko, AU - Faden,Howard, Y1 - 2004/11/10/ PY - 2003/12/29/received PY - 2004/09/22/accepted PY - 2004/11/19/pubmed PY - 2005/4/13/medline PY - 2004/11/19/entrez SP - 3 EP - 8 JF - European journal of pediatrics JO - Eur. J. Pediatr. VL - 164 IS - 1 N2 - UNLABELLED: To determine outcomes in acute otitis media (AOM) according to severity of disease and to assess different initial treatment regimens, 308 with AOM were enrolled and divided into severe (n = 277; 89.9%) and non-severe (n = 31; 10.1%) groups based on symptoms and tympanic membrane changes. Children in the severe group were initially managed with amoxicillin (AMPC) whereas children in the non-severe group were initially managed without antibiotics. Children were monitored on days 1, 5, 10, 14 and 28. Five outcome measures were assessed: disappearance of symptoms at day 5, resolution of tympanic membrane changes by day 28, disappearance of middle ear effusions by day 28, recurrence of acute symptoms prior to day 28, and need to change treatment regimens. Children with severe disease were more often male (57% versus 36%, P < 0.05) and more often colonized with pathogens (77% versus 55%, P < 0.05 than children with non-severe disease. The two groups were similar with respect to age and day care attendance. Despite differences in initial treatment regimens between the two groups, symptoms improved at the same rate for severe and non-severe disease, 94% by day 5. In contrast, tympanic membranes returned to normal in 69% of the severe and 81% of the non-severe groups by day 28; however, as early as day 5, 10% of the severe and 55% of the non-severe groups demonstrated normal tympanic membranes. Middle ear effusions similarly disappeared more slowly in the severe group, 52% versus 74% by day 14 and 76% versus 84% by day 28. Recurrence rates of acute symptoms occurred with equal frequency in the severe, 15%, and non-severe groups, 10%. Failure of the symptoms or the tympanic membranes to improve led to antibiotic changes in 59.9% of the severe group and to the addition of antibiotics in 51.6% of the non-severe group. Children in the severe group who failed to improve with an initial course of amoxicillin were younger (40.2 months versus 45.8 months, P < 0.05), had higher tympanic membrane scores (4.5 versus 4.1, P < 0.05), and were more often colonized with penicillin-resistant Streptococcus pneumoniae (33.8% versus 6.5%, P < 0.01) than children who responded to AMPC. In a similar manner, children with non-severe disease who failed to improve without antibiotics were younger (40.7 months versus 54.8 months, P < 0.05) and more often colonized with pathogens (75.0% versus 33.4%, P < 0.05). CONCLUSION: Severe disease occurred more often among males and among children colonized with pathogens. Response to treatment was impaired in younger children and in children colonized with pathogens, especially penicillin-resistant Streptococcus pneumoniae. SN - 0340-6199 UR - https://www.unboundmedicine.com/medline/citation/15549378/Treatment_and_outcome_of_severe_and_non_severe_acute_otitis_media_ L2 - https://dx.doi.org/10.1007/s00431-004-1564-0 DB - PRIME DP - Unbound Medicine ER -