PITTSBURGH -- Children's Hospital of Pittsburgh announced today that consensus recommendations for the treatment of acute otitis media (AOM) are published in the current issue of Clinical Pediatrics. The guidelines underscore the need for accurate diagnosis of AOM, or middle ear infections, and provide strict criteria that identify patients at risk for resistant bacteria. They also emphasize the need to initiate antibiotics with superior efficacy against resistant bacteria strains for patients who have risk factors for persistent and difficult-to-treat AOM.
AOM is the most common bacterial respiratory tract infection in the pediatric population. Three out of four children experience at least one middle ear infection before they are 3 years old, and of these children almost half experience three or more episodes.
With a great deal of variability as to the diagnosis and optimal management of AOM, the guidelines recommend that physicians and parents know the factors that put children at high risk for developing AOM with resistant bacteria. These include:
Patients under 2 years old
Children who attend day care
Children who have been exposed to antibiotics within the past 1 to 3 months
Winter and spring seasons
The guidelines recommend amoxicillin, especially at higher doses, as first-line treatment for AOM. However, if a patient has a risk factor or has AOM symptoms for more than three days, the guidelines call for treatment with Augmentin ES-600 (amoxicillin/clavulanate). As an alternative, patients also can be treated with three injections of Rocephin (ceftriaxone sodium). However, based on limited clinical experience compared to oral agents, it may be advisable to reserve this injectable cephalosporin therapy for use in severe infections only.
"Ten to 15 years ago, there were a dozen antibiotics that worked, but because the bacteria that cause ear infections have developed resistance, today only a few antibiotics can treat ear infections effectively," said Alejandro Hoberman, MD, chief of the Division of General Academic Pediatrics at Children's Hospital of Pittsburgh and associate professor of Pediatrics at the University of Pittsburgh School of Medicine. "Both physicians and parents need to understand that many children have risk factors and should receive treatment with an antibiotic that covers resistant bacteria, such as Augmentin ES-600, which is the only oral antibiotic recommended for these more 'difficult-to-treat' AOM."
AOM is a condition characterized by inflammation or infection of the middle ear, and is one the leading causes of office visits and antibiotic prescriptions for infants and children. Increasing resistance among the bacteria that cause middle ear infections presents a clinical challenge for practitioners. "In this age of antibiotic resistance, choosing an antibiotic with a slightly higher bacteriologic success rate translates into a significant number of clinical successes that not only help parents and their sick children feel better, but could have a tremendous positive impact on public health by reducing treatment failures and unnecessary use of additional antibiotics," said Hoberman.
The guidelines additionally recommend that the pneumococcal vaccine may provide an effective means of reducing AOM episodes, office visits, recurrent AOM, and tympanostomy tube insertion and should be considered appropriate for patients younger than 2 years old, particularly those at high risk of infection with resistant pneumococci.
The Treatment of Acute Otitis Media Consensus Recommendations were developed during a roundtable meeting sponsored by SmithKline Beecham that convened clinicians versed in AOM.