Acute otitis media to treat or not to treat
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Acute Otitis Media To treat or not to treat. Gary Kroukamp. Introduction. Concern about antibiotic resistance Overuse of antibiotics, over diagnosis of AOM Most will improve spontaneously without antibiotics Normal part of childhood? 95% of kids by age 7 Part of viral URTI

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Acute Otitis Media To treat or not to treat

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Acute otitis media to treat or not to treat

Acute Otitis MediaTo treat or not to treat

Gary Kroukamp


Introduction

Introduction

  • Concern about antibiotic resistance

  • Overuse of antibiotics, over diagnosis of AOM

  • Most will improve spontaneously without antibiotics

  • Normal part of childhood? 95% of kids by age 7

  • Part of viral URTI

  • Netherlands vs Australia


Major controversies

Major controversies

  • To treat or not to treat AOM with antibiotics

  • To treat or not to treat MEE that persists after treatment of AOM with antibiotics

  • To treat or not to treat OME with antibiotics

  • Which management options are safe and effective for prevention of recurrent AOM


Microbiology

Microbiology

  • Bacterial pathogens found in 70% of AOM and 30% of OME

  • S. Pneumoniae – 40%

  • H. Influenzae – 25%

  • M. Catarrhalis – 12%

  • Beta-haemolytic strep and Staph. Aureus

  • Beta lactamase production in 25% of Haemophilus and all Moraxella

  • Drug resistance in S.Pneumoniae is increasing


Against antibiotics

Against antibiotics

  • Australia 98% vs. Netherlands 31% (vs Africa?) – no difference in complications

  • European literature suggests non-antibiotic treatment has low complication rate and may be intercepted


Evidence for antibiotics vs placebo

Evidence for Antibiotics (vs Placebo)

  • Sterilises the effusion – Howie et al 1972

  • Earlier resolution of symptoms – Rosenfeld et al (metanalysis 5400 children) 81% vs 95% resolution

  • Shortens time of MEE – Kaleida et al, 2 weeks of antibiotics 47% vs 63%

  • Decreases suppurative complications – mastoiditis and meningitis almost exclusively in placebo treated kids

  • S. Pneumonia tends not to resolve spontaneously (20%)


Conclusion

Conclusion

  • Treatment justified in SA

  • If part of viral URTI may be watched if close follow-up is guaranteed

  • Medico-legal implications of not treating?


Selection of antibiotic

Selection of Antibiotic

  • High dose amoxycillin

  • Co-amoxyclav

  • Cephalosporin

  • Shorter courses?


To treat or not to treat persistent mee with antibiotics

To treat or not to treat persistent MEE with antibiotics

  • MEE in 50% after treatment of AOM

  • 90% resolve in 3 months

  • Antibiotics not indicated

  • Treat as for OME


Recurrent aom 3 in 6 months or 4 in 12 months

Recurrent AOM 3 in 6 months or 4 in 12 months

  • Prevention

    • Smoking

    • Crèche

    • Vaccination – pneumococcal and flu

    • Antibiotic prophylaxis

    • Grommets

    • Adenoidectomy


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