Otitis Media

Jo, Hendley

doi:10.1056/nejmcp010944

Cited by 94 publications

(39 citation statements)

References 31 publications

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“…In order to attain the maximal drug efficacy and avoid resistance, it is recommended that antibiotics and doses be chosen based on results of local antimicrobial susceptibility studies, that the organism most probably involved be taken into account, and that the drug be administered for short time periods (5,13,14). As far as the delay of antibiotic treatment is concerned, it is not easy to extrapolate the results obtained in the animal model to human medicine, but our results suggest that if antibiotics are indicated in cases of AOM they should be administered very early, as recently proposed by Handley (14), especially in countries where the organism may have diminished susceptibility to the administered drug. This attitude should lead to the achievement of maximal efficacy and at the same time may prevent serious complications (28).…”

Section: Discussionmentioning

confidence: 99%

“…Infection with pneumococci seems to be more serious and less likely to clear spontaneously than infection with other AOM-causing pathogens (3,27). Although other organisms, even ␤-lactamase producers, may be responsible for AOM, amoxicillin continues to be one of the most recommended drugs for treatment (5,14). Up to 80% of children with AOM will resolve the infection within 1 week without antibiotic treatment, and only 13% will be benefited by such treatment (24).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Effect of Antibiotic Treatment Delay on Therapeutic Outcome of Experimental Acute Otitis Media Caused by Streptococcus pneumoniae Strains with Different Susceptibilities to Amoxicillin

Parra¹,

Ponte²,

Cenjor

et al. 2004

Antimicrob Agents Chemother

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Antibiotic Treatment Delay on Therapeutic Outcome of Experimental Acute Otitis Media Caused by Streptococcus pneumoniae Strains with Different Susceptibilities to Amoxicillin

Parra¹,

Ponte²,

Cenjor

et al. 2004

Antimicrob Agents Chemother

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“…2 and Fisher exact tests were used to analyze categorical variables, and analysis of variance and paired t test were used for continuous variables. For performing a more powerful multivariate analysis, data were entered into a multivariate stepwise linear regression model in which the dependent variable was the change in pain level over time (from baseline to day 3) and the independent (explanatory) variables were 1) age (years)…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, acute otitis media (AOM) is diagnosed Ͼ5 million times per year and is the most common reason for prescription of antibiotics in children. 2 Otalgia is the hallmark of AOM. Most affected children either complain of earache or manifest behaviors that the parents interpret as indicating ear pain.…”

mentioning

confidence: 99%

Naturopathic Treatment for Ear Pain in Children

2003

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ABSTRACT.Objective. Otitis media is 1 of the most frequent diseases of early infancy and childhood and 1 of the most common reasons for children to visit a physician. In the past 2 decades, there has been a substantial increase in the diagnosis of otitis media worldwide. In the United States, 93% of all children have had at least 1 episode of acute otitis media (AOM) by 7 years of age. Otalgia is the hallmark of AOM. Most affected children either complain of earache or manifest behavior that the parents interpret as indicating ear pain. Treatment of the ear pain early in the course of AOM decreases both parental anxiety and the child's discomfort and accelerates the healing process. The objective of this study was to determine the efficacy and tolerability of naturopathic versus traditional treatment for the management of otalgia commonly associated with AOM in children.Methods. The study was designed as a double-blind trial in an outpatient community clinic. A total of 171 children who were aged 5 to 18 years and had otalgia and clinical findings associated with middle-ear infection were studied. The children were randomly assigned to receive treatment with Naturopathic Herbal Extract Ear Drops (NHED) or anesthetic ear drops, with or without amoxicillin. On enrollment, the children were assigned by computer-numbered randomization to receive NHED (contents: allium sativum, verbascum thapsus, calendula flores, hypericum perfoliatum, lavender, and vitamin E in olive oil) 5 drops 3 times daily, alone (group A) or together with a topical anesthetic (amethocaine and phenazone in glycerin) 5 drops 3 times daily (group B), or oral amoxicillin 80 mg/kg/d (maximum 500 mg/dose) divided into 3 doses with either NHED 5 drops 3 times daily (group C) or topical anesthetic 5 drops 3 times daily (group D). A double-blind design was used, and all ear drops were placed in identical bottles. Treatment was initiated by the nurse in all cases. A single physician (M.S.) evaluated and treated all of the patients included in the study and recorded all of the data. The presence or absence of ear pain was assessed over 3 days with a visual analog scale. Ear pain was assessed by a specially devised observational instrument based on previous reports. One side of the instrument consisted of a linear numbered scale, from 1 (no pain) to 10 (worst possible pain), and a corresponding color scale, ranging from blue to dark red. The reverse side contained a scale of 5 facial expressions, ranging from broad smile (no pain) to a sad and crying face (worst possible pain), and a corresponding color scale, ranging from blue to dark red.Results. There were no significant between-group differences in patient age or gender, degree of fever, main symptoms, associated symptoms, and severity or laterality of acute otitis media. Each group had a statistically significant improvement in ear pain over the course of the 3 days. Patients who were given ear drops alone had a better response than patients who were given ear drops together with amoxicillin. Results...

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“…Early therapy clearly correlated with improved effectiveness; therefore, if antibiotics are indicated, they should be administered, combined with ibuprofen, as early as possible. This therapeutic approach, which has been proposed by some authors (19,20), may lead to achieving maximal effectiveness and preventing serious complications (21).…”

Section: Discussionmentioning

confidence: 99%

Impact of Ibuprofen Therapy in the Outcome of Experimental Pneumococcal Acute Otitis Media Treated With Amoxicillin or Erythromycin

et al. 2006

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ABSTRACT:The impact of ibuprofen combined with amoxicillin or erythromycin for therapy of penicillin-resistant pneumococcal acute otitis media (AOM) was evaluated in a gerbil model. Ibuprofen (at 2.5 or 7.5 mg/kg, orally) and/or amoxicillin or erythromycin (5 mg/kg each, s.c.) were administered at 5 h (early therapy, as singledose regimen) or at 18 h (delayed therapy, five doses) postinoculation (PI). Each antibiotic alone and combined with ibuprofen was more effective administered as early regimen than as delayed treatment when evaluating the presence of otorrhea, otoscopic aspect, culturepositive and bacterial counts in middle ear (ME) samples, and loss of body weight. There was a trend for a better bacteriological outcome in animals receiving amoxicillin or erythromycin and ibuprofen, especially with the high dose. Such a dose of ibuprofen, associated with each antibiotic regimen, also preserved the animal well-being, avoiding a great weight loss in comparison to those receiving the antibiotic alone but a statistically significant difference was only observed for animals receiving delayed therapy with erythromycin and high-dose ibuprofen. In conclusion, ibuprofen combined with antibiotics seemed to improve the outcome of this experimental pneumococcal AOM. A OM is one of the most frequently diagnosed infectious diseases and the most common reason for antibiotic prescriptions written for children in many countries (1). Most experts recommend empirical antimicrobial treatment of AOM in children to eradicate the pathogen and the use of an anti-inflammatory or analgesic drug such as ibuprofen or acetaminophen to relieve the symptoms (2,3). Acetaminophen acts as a weak inhibitor of the synthesis of prostaglandins inhibiting cyclooxygenase (COX)-2-dependent pathways (4). In contrast, ibuprofen inhibits both COX-1 and COX-2 having more potent analgesic and anti-inflammatory effects (5). We previously demonstrated using an experimental AOM model caused by Streptococcus pneumoniae that acetaminophen combined with amoxicillin/clavulanic acid or erythromycin had neither a synergistic nor an antagonistic effect on the antipneumococcal activity (6). Therefore, use of acetaminophen to alleviate ear pain and decrease body temperature (3) may be advocated alone or combined with an antibiotic in the management of AOM. We selected ibuprofen, a potent antiinflammatory drug, to determine its effect when combined with antimicrobial treatment on the outcome of penicillinresistant pneumococcal AOM in a gerbil model. METHODS Bacteria.A strain of S. pneumoniae serotype 23 F [minimum inhibitory concentration (MIC) for benzylpenicillin ϭ 2 g/mL] isolated from a bacteremic patient was used.Pharmacological compounds. Ibuprofen sodium salt and erythromycin (Sigma Chemical Co., St. Louis, MO) and amoxicillin trihydrate (GlaxoSmithKline, Worthing, UK) were used for in vitro studies. For in vivo (therapeutic) use, Junifen, an ibuprofen suspension (Boots Healthcare International, Nottingham, UK), was used diluted with sterile distilled water ...

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Otitis Media

Cited by 94 publications

References 31 publications

Effect of Antibiotic Treatment Delay on Therapeutic Outcome of Experimental Acute Otitis Media Caused by Streptococcus pneumoniae Strains with Different Susceptibilities to Amoxicillin

Effect of Antibiotic Treatment Delay on Therapeutic Outcome of Experimental Acute Otitis Media Caused by Streptococcus pneumoniae Strains with Different Susceptibilities to Amoxicillin

Naturopathic Treatment for Ear Pain in Children

Impact of Ibuprofen Therapy in the Outcome of Experimental Pneumococcal Acute Otitis Media Treated With Amoxicillin or Erythromycin

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