Acute otitis media: Which children to treat

August 9, 2017|Pediatric News

FROM PEDIATRICS

Children whose ear infections involve severe bulging of the eardrum are likely to benefit from antibiotic treatment, while children with a peaked tympanogram pattern are likely to recover from the infections without the use of antibiotics, according to results from a new study.

The findings, published online Aug. 8 (Pediatrics. 2017), may help restrict pediatricians’ use of antibiotics to the patients who are most likely to benefit. For their research, Paula A. Tähtinen, MD, PhD, of Turku (Finland) University Hospital, and her colleagues, analyzed results from a previous placebo-controlled trial of 319 children in Finland with acute otitis media. Subjects were aged 6-35 months (median age 14 months; 57% boys; 99% white). The children in the cohort were evenly randomized to treatment with amoxicillin or placebo for 7 days. In the antibiotic arm, about 19% of patients failed to respond to treatment, while about 45% in the placebo arm did.

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The researchers found, looking at results from across groups, that a peaked tympanogram result at the start of the study lowered the risk of treatment failure (hazard ratio 0.43, 95% confidence interval 0.21-0.88, P = 0.02). They also found that the biggest between-group differences in treatment failure occurred among children with severe bulging of the tympanic membrane, defined by the authors as “convexity markedly increased beyond the edges of tympanic membrane, resembling a doughnut” (11.1% vs. 64.1%, rate difference −53.0%; 95% CI, −73.5% to −32.4%). The number needed to treat among children with severe bulging was 1.9, indicating that 2 children need to be treated with antimicrobial agents to prevent treatment failure in 1 child.

Dr. Tähtinen and her colleagues noted that in their study, severe bulging was an important prognostic factor irrespective of the number of ears affected or the severity of other common symptoms such as pain or fever. In this study, involvement of both ears and severity of other symptoms such as pain or fever were not seen affecting risk of treatment failure. Though only a minority of children in the study had a peaked tympanogram, failure rates for these were low in both treatment and placebo groups, and the number needed to treat to prevent treatment failure was 1 in 29.

“The evaluation of otoscopic signs is always subjective and prone to interobserver bias,” the researchers wrote. “Severe bulging is, however, a sign that is difficult to miss even for a less experienced otoscopist, and therefore this prognostic factor as an indication for antimicrobial treatment could be easily applied into clinical practice.”

Dr. Tähtinen and her colleagues’ research was supported by grants from the European Society for Pediatric Infectious Diseases and several other foundations. The study authors disclosed no financial conflicts of interest.