Antimicrobial prophylaxis for infants at risk for recurrent acute otitis media

Teele, David W.; Klein, Jerome O.; Word, Bonnie M.; Rosner, Bernard; Starobin, Sidney G.; Earle, Ralph; Ertel, Corrine S; Fisch, Gilbert R.; Michaels, R H; Heppen, R.; Strause, N.Philip

doi:10.1016/s0264-410x(00)00293-0

Cited by 30 publications

(28 citation statements)

References 11 publications

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“…Teele showed no differences between children who received prophylactic antibiotics compared with those who received placebo in AOM recurrences or persistence of OME. 198 Antibiotic prophylaxis is not appropriate for children with long-term MEE or for children with infrequent episodes of AOM. The small reduction in frequency of AOM with long-term antibiotic prophylaxis must be weighed against the cost of such therapy; the potential adverse effects of antibiotics, principally allergic reaction and gastrointestinal tract consequences, such as diarrhea; and their contribution to the emergence of bacterial resistance.…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

1,089

832

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This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM.In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations.The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships.The practice guideline underwent comprehensive peer review before formal approval by the AAP.This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem. Pediatrics 2013;131:e964-e999

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Section: Antibiotic Prophylaxismentioning

confidence: 99%

The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

1,089

832

View full text Add to dashboard Cite

show abstract

“…Due to the ability of this organism to cause disease in both children and adults, there are substantial health care costs associated with these infections (26). Also of major concern is the expression of ␤-lactamase by greater than 90% of all M. catarrhalis clinical isolates, resulting in resistance to the commonly prescribed antibacterial drug amoxicillin and certain cephalosporins (12,21,27).…”

mentioning

confidence: 99%

Identification of a Hemin Utilization Protein of Moraxella catarrhalis (HumA)

Furano¹,

Campagnari

2004

Infect Immun

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Moraxella catarrhalis is a major cause of acute otitis media in young children and has also been implicated as an important cause of exacerbations in adults with underlying pulmonary disease. Due to the considerable level of antibiotic resistance and the high degree of carriage rates in young children, it is likely that the incidence of M. catarrhalis infections will continue to rise. M. catarrhalis is a strict human respiratory pathogen, and this bacterium uses both transferrin and lactoferrin receptors to fulfill the essential iron requirement for survival in vivo. However, these are the only described iron acquisition systems for this organism. In this report we have demonstrated that M. catarrhalis can also utilize hemin as a sole source of iron for growth. In addition, we have identified and characterized an outer membrane protein with homology (26 to 28% similarity) to other known hemin binding and uptake proteins in related gram-negative organisms (i.e., Bordetella and Yersinia spp.). This newly described M. catarrhalis protein, termed HumA, is capable of directly binding to hemin coupled to a solid-phase matrix. M. catarrhalis HumA expressed on the surface of an Escherichia coli hemAdeficient strain (K-12 EB53) is fully capable of complementing the defect and thus restoring the ability of this strain to grow in the presence of hemin. When M. catarrhalis is grown in the presence of hemin, HumA expression is clearly increased as shown by Western blotting with polyclonal antiserum developed against a HumA peptide. In addition, growth analyses revealed that a HumA-deficient mutant of M. catarrhalis (7169::humA) is restricted for growth in the presence of hemin as the sole iron source compared to the wild-type strain. We conclude that HumA is an essential component of a hemin uptake and utilization system previously undescribed for M. catarrhalis, thus providing another mechanism of iron acquisition that may facilitate persistent colonization of the mucosal surface.Moraxella catarrhalis, a gram-negative diplococcus bacterium, continues to emerge as a leading human mucosal pathogen. The most recent data reveal that M. catarrhalis remains one of the three leading causes of acute otitis media (AOM) in children (21). In addition to AOM, this pathogen is now becoming recognized as a factor in episodes of acute bacterial rhinosinusitis in children (1). M. catarrhalis is also a welldocumented cause of exacerbations in adults with chronic obstructive pulmonary disease (2, 16).Due to the ability of this organism to cause disease in both children and adults, there are substantial health care costs associated with these infections (26). Also of major concern is the expression of ␤-lactamase by greater than 90% of all M. catarrhalis clinical isolates, resulting in resistance to the commonly prescribed antibacterial drug amoxicillin and certain cephalosporins (12,21,27). Clinical studies have revealed the inability to distinguish infection caused by M. catarrhalis from other pathogens based solely on symptomology, subsequ...

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“…In the light of this paradigmatic shift, the efficacy of antibiotics as treatment and prophylaxis must be scrutinized. Early studies on young children with rAOM showed that antibiotics could provide protection against OM recurrence and frequency of AOM episodes [45–47], with amoxicillin appearing as the drug of choice. In a recent review comparing studies on antibiotic prophylaxis, adenoidectomy, and tympanostomy tube insertion (TT) [48], antibiotic prophylaxis proved to be the most effective preventive treatment.…”

Section: Preventionmentioning

confidence: 99%

Recurrent Acute Otitis Media: What Are the Options for Treatment and Prevention?

Granath

2017

Curr Otorhinolaryngol Rep

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Purpose of ReviewTo survey current strategies for treatment and prevention of recurrent acute otitis media (rAOM).Recent FindingsTreatment with systemic antibiotics is required in recurrent episodes of acute otitis media. A cautious attitude is recommended due to antibiotic resistance. Antibiotics also provide effective prophylaxis for rAOM. Topical treatment with ear drops is recommended in rAOM with otorrhea from tympanostomy tubes. Pneumococcal conjugated vaccines seem to have a moderate reductive effect on overall otitis media. The effect on rAOM is still unclear. Different administrations of immunoglobulins have not been effective against rAOM. Breastfeeding had a protective effect against rAOM. A recommendation against cigarette smoke exposure as a measure to prevent otitis seems warranted. An effect for adenoidectomy in children <2 years old with rAOM has been suggested. There is a strong genetic connection with rAOM. Probiotics and nasal spray with Streptococci might offer future opportunities as prophylaxis. Too little is known about complimentary treatments to give any recommendations.SummarySystemic antibiotics are still needed as treatment against episodes of AOM in rAOM children. There are several preventive measures that can be taken to reduce the burden of AOM but they all have a small-moderate effect. Systemic antibiotics provide effective prophylaxis in rAOM, but must be used with extreme caution due to the emerging antibiotic resistance.

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Antimicrobial prophylaxis for infants at risk for recurrent acute otitis media

Cited by 30 publications

References 11 publications

The Diagnosis and Management of Acute Otitis Media

The Diagnosis and Management of Acute Otitis Media

Identification of a Hemin Utilization Protein of Moraxella catarrhalis (HumA)

Recurrent Acute Otitis Media: What Are the Options for Treatment and Prevention?

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