Review Notes Shift in Otitis Media Microbiology After PCV7

Antibiotic treatment only modestly more effective than no treatment for acute otitis media

TUESDAY, Nov. 16 (HealthDay News) -- Though the microbiology of acute otitis media (AOM) has shifted, there is still no gold standard for diagnosis or treatment of the condition, according to research published in the Nov. 17 issue of the Journal of the American Medical Association.

Tumaini R. Coker, M.D., of the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues performed a systematic review of AOM diagnosis and treatment and the association of AOM microbiology with heptavalent pneumococcal conjugate vaccine (PCV7). Included in the analysis were 135 citations.

The researchers found that, for studies assessing AOM diagnosis, only otoscopic findings of tympanic membrane bulging (positive likelihood ratio, 51) and redness (positive likelihood ratio, 8.4) were associated with accurate diagnosis -- not clinical symptoms. Since the introduction of PCV7, the prevalence of Haemophilus influenzae increased while the prevalence of Streptococcus pneumonia decreased. Early use of either ampicillin or amoxicillin was associated with a 12 percent greater pooled clinical success rate but the rate of rash or diarrhea increased by 3 to 5 percent when these antibiotics were used. No antibiotic demonstrated clear superiority over amoxicillin.

"Of 100 average-risk children with AOM, approximately 80 would likely get better within about three days without antibiotics. If all were treated with immediate ampicillin/amoxicillin, an additional 12 would likely improve, but three to 10 children would develop rash and five to 10 would develop diarrhea," the authors write.

One author disclosed previously holding shares in Pfizer.

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