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Acute Otitis Media: Do the Current Guidelines Work?

A recent evaluation supports the AAP and CDC treatment recommendations.

Concerns about resistant Streptococcus pneumoniae, frequent treatment failures and relapses, and lack of specific bacteriologic information for individual patients make the treatment of acute otitis media (AOM) one of the most frustrating issues in daily practice. The CDC and the AAP recommend that high-dose amoxicillin be used to treat AOM in areas with high levels of S. pneumoniae resistance. These researchers used tympanocentesis to evaluate this recommendation and to examine treatment failures.

Fifty patients with AOM and tympanocentesis-proven bacterial disease (age range, 3 months to 36 months) were treated with 80 mg/kg/day of amoxicillin for 10 days. Each patient underwent a second tympanocentesis between days 3 and 5. The overall bacterial eradication rate was 82%, and most failures involved beta-lactamase-positive Haemophilus influenzae. Only 3 patients (6%) experienced clinical failure. Seven of 35 children who were followed for 1 month (20%) experienced relapse; the middle ear fluid in these patients contained both old and new pathogens.

Comment: These authors provide excellent bacteriologic evidence that our current strategy for AOM is working. For the few patients who don't respond to high-dose amoxicillin, the logical next step is to add a beta-lactamase inhibitor to the regimen. Although S. pneumonia resistance continues to be worrisome, the bacteriologic evidence shows that most failures can be treated with amoxicillin-clavulanate and that the need to resort to ceftriaxone therapy is rare.

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 14, 2003

Citation(s):

Piglansky L et al. Bacteriologic and clinical efficacy of high dose amoxicillin for therapy of acute otitis media in children. Pediatr Infect Dis J 2003 May; 22:405-12.

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