Trial Gives A Nod To Antimicrobial Treatment For Acute Otitis Media In Children

The much asked question "Can acute otitis media (AOM) be treated well with antibiotics in young children” had been a topic of serious discussion for a long period. The answer is “Yes” and is strongly backed by a recent study conducted by Paula A. Tahtinen, M.D and her colleagues at the Turku University Hospital in Finland. 319 children aged between 6 to 35 months with a carefully diagnosed acute otitis media were part of the study. 161 children received amoxicillin-clavulanate while the remaining were given placebo for 7 days. Treatment failure was seen in 30 of the 161 children who were given amoxicillin-clavulanate and in 71 of the 158 children who were given placebo. Thus the treatment failure was significantly less common in the antibiotic group as opposed to the placebo group (18.6% vs. 44.9%). 

Researchers also found that although the incidence of side-effects is more among children who received antibiotics. Children who received antibiotics were more likely to develop side effects like diarrhea (47.8% vs. 26.6%) and eczema. However to minimize unnecessary antimicrobial treatment and development of bacterial resistance further studies have to be conducted to identify patients who may derive the greatest benefit. Towards the end of the study period it was seen that the presence of pathogenic bacteria is less in the nasopharynx of children who were treated with amoxicillin-clavulanate.

The study holds a lot of significance as physicians across the globe are reluctant to give antibiotics indiscriminately because of the probable side effects like diarrhea, oral thrush, yeast infections, allergic reactions and most importantly “resistant bacteria”.

Leading AOM expert, Dr. Jerome O.Klein from Boston University School of Medicine in Boston states that, "Young children with diagnosis of acute otitis media recover more quickly when they are treated with an appropriate antimicrobial agent because in most cases, AOM is caused by bacteria sensitive to amoxicillin-clavulanate”. He strongly believes that, “The issue isn't whether young children with AOM benefit from antibiotics, but whether the diagnosis of AOM is accurate. The trial highlighted the known adverse effects associated with use of antibiotics but do not address other serious complications such as mastoiditis. The young children with AOM get better faster when they are treated with antibiotics, but treatment decisions must be balanced against the risk for adverse effects, particularly diarrhea.”

Peggy Sue Weintrub, MD, Clinical Professor and Chief of Pediatric Infectious Diseases at the University of California, look towards the study and its result in a different light. She said, “The question that remains is-When do we need to treat and when can we watch and wait? Placebo was definitely a successful option for more than half the children in the study. For children who look well, are old enough to easily evaluate, and can be comforted with supportive care (Tylenol and TLC), watchful waiting remains in my armamentarium. Parental wishes, history of prior infections, concerns about excess antibiotic use, and adverse effects still factor into my decision. Finally, although amoxicillin-clavulanate was used in the study, amoxicillin alone is still first-line therapy forchildren.”

The study holds a lot of significance as many physicians across the globe are reluctant to give antibiotics indiscriminately because of its probable side effects like diarrhea, oral thrush, yeast infections, allergic reactions and most importantly bacterial resistance.

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Reference:
http://www.nejm.org/doi/full/10.1056/NEJMoa1007174

Source-Medindia