Acute Otitis Media. Aspects of diagnosis and prophylaxis
(2006)- Abstract
- Acute otitis media (AOM) is one of the most common childhood diseases and the most common causes of antibiotic treatment in small children. Most children will experience one or two episodes of AOM during preschool age but some will suffer from repeated attacks, they will become otitis-prone. Complications with severe, sometimes fatal infections such as acute mastoiditis and meningitis are nowadays rare but does still exist.
The major pathogens found in AOM are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. During the last decades all these common upper airway bacteria have developed various degrees of resistance against antibiotics. Several studies have related these... (More) - Acute otitis media (AOM) is one of the most common childhood diseases and the most common causes of antibiotic treatment in small children. Most children will experience one or two episodes of AOM during preschool age but some will suffer from repeated attacks, they will become otitis-prone. Complications with severe, sometimes fatal infections such as acute mastoiditis and meningitis are nowadays rare but does still exist.
The major pathogens found in AOM are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. During the last decades all these common upper airway bacteria have developed various degrees of resistance against antibiotics. Several studies have related these problems to a large consumption of antibiotics especially in small children. It is of great interest to reduce the antibiotic consumption in these small children without raising the number of serious complications.
In the first two studies intermittent antibiotic prophylaxis at upper respiratory tract infections (URTI) was tested as a method of reducing the number of AOM episodes in small otitis prone children. Long time prophylaxis with antibiotics have been shown to be effective but raises the antibiotic consumption very much. The prophylactic model studied here was treatment with a short-term penicillin V course of 5 days at episodes of URTI. It was shown that this seemed effective in the slightly older patients in the first study but that this method was not effective in the younger truly otitis prone children. The children in this study were treated with large quantities of pcV during the study period of one year, but there was no change in the upper airway bacteria regarding the susceptibility to betalactams in the S. pneumoniae or the ?-laktamase-production in the H. influenzae.
Most complications in AOM are caused by the gram+ bacteria while most AOM caused by gram- bacteria will heal without treatment. If we could differentiate the potentially dangerous bacteria from the more harmless ones at the diagnostic moment we might be able to chose treatment more judiciously and thus lower the number of antibiotic treatments without raising the number of complications. An experimental study showed that we were able to predict the type of bacteria responsible for the infection regarding gram-positive (S. pneumoniae and S. pyogenes) and gram-negative bacteria (H. influenzae and M. catarrhalis). The same was possible in humans studied at the ENT department in Skövde during optimal conditions.
In summary; prophylaxis at URTI in children with penicillin V in a short-term period did not reduce the amount of episodes of AOM in the younger truly otitis-prone children. The antibiotic susceptibility for penicillin in the S. pneumoniae during these repetitive courses of pcV did not change and the H. influenzae did not produce more ?-laktamase.
It was possible to predict whether a gram+ or gram ? bacteria was the causing pathogen in an experimental and a human setting which further emphasises the need of better diagnosis in AOM. (Less) - Abstract (Swedish)
- Popular Abstract in Swedish
Akut mellanöreinflammation (akut otitis media, AOM) är en av barnaålderns vanligaste sjukdomare och en av dem som oftast föranleder antibiotikabehandling. De flesta barn får bara någon enstaka AOM, men cirka 5% av dem som insjuknar drabbas sedan av upprepade infektioner (s.k. otit-benägna barn) och blir till ett problem både för patienten, dennes familj och samhället. Den frekventa antibiotikaanvändningen vid dessa tillstånd har också lett till en resistensutveckling mot antibiotika hos de bakterier som orsakar AOM. Syftet med denna avhandling var att undersöka om förebyggande antibiotikabehandling vid symptom på övre luftvägsinfektion (ÖLI) hindrade utvecklingen av AOM hos otitbenägna barn och... (More) - Popular Abstract in Swedish
Akut mellanöreinflammation (akut otitis media, AOM) är en av barnaålderns vanligaste sjukdomare och en av dem som oftast föranleder antibiotikabehandling. De flesta barn får bara någon enstaka AOM, men cirka 5% av dem som insjuknar drabbas sedan av upprepade infektioner (s.k. otit-benägna barn) och blir till ett problem både för patienten, dennes familj och samhället. Den frekventa antibiotikaanvändningen vid dessa tillstånd har också lett till en resistensutveckling mot antibiotika hos de bakterier som orsakar AOM. Syftet med denna avhandling var att undersöka om förebyggande antibiotikabehandling vid symptom på övre luftvägsinfektion (ÖLI) hindrade utvecklingen av AOM hos otitbenägna barn och hur detta påverkade de aktuella bakterierna ur resistenssynpunkt. Dessutom avsåg man, att undersöka om man enbart genom mikroskopisk inspektion av trumhinnan kunna fastställa vilken bakterie som orsakat den aktuella infektionen.
I studie I inkluderades barn under 18 månaders ålder, som haft minst 3 AOM. Vid tecken till ÖLI (snuva, temperaturstegring, hosta) gavs försöksmedicin i form av penicillin V (PcV) eller placebo. Inom 3 dygn undersöktes barnen med öronmikroskopi för att bekräfta eller utesluta AOM. Bakterieodling från nässvalget togs också vid undersökningstillfället. Patienterna följdes under 4.5 månader.I gruppen som fått PcV noterades en minskad frekvens AOM jämfört med placebogruppen. Odlingarna från de patienter som erhållit försöksmedicin i minst 2 dagar visade att S. pneumoniae (pneumococcer) förekom i en lägre frekvens hos dem som fått PcV jämfört med de som fått placebo.
Den andra studien omfattade barn som före 6 månaders ålder haft en AOM konstaterad av öronläkare. I övrigt var uppläggningen identisk med den i studie I frånsett att patienterna följdes under 12 månader. De förändrade urvalskriterierna för patienter motiverades av att frekvensen AOM hos de i studie I inkluderade barnen varit lägre än förväntad. Resultaten visade att båda grupperna fick lika hög frekvens AOM, någon förebyggande effekt av PcV kunde inte noteras. Däremot hade 48/70 inkluderade barn haft mer än 3 AOM-episoder under studietiden, vilket talar för att urvalskriterierna fångat upp otit-benägna barn.
Det tredje arbetet är en bakteriologisk studie baserad på prov tagna från patienterna i studie II. Sammanlagt omfattade materialet 703 odlingar. Patienterna, som deltog i studie II, hade under studieåret konsumerat 7 respektive 5 kurer antibiotika i PcV- respektive placebogruppen. Trots detta kunde man inte hos någon av de isolerade stammarna av S. pneumoniae eller H. influenzae i något avseende konstatera en ökad resistens.
I den fjärde studien framkallades AOM experimentellt hos olika grupper av råttor med de vid otit vanligast förekommande bakterierna. Trumhinnans utseende under försöksperioden dokumenterades och hos en del av försöksdjuren bestämdes också halten av det vid inflammatoriska processer bildade cytokinet IL-6. Resultatet visade att man genom trumhinnans utseende kunde avgöra vilka djur som infekterats med komplikationsbenägna bakterier (S. pneumoniae och S. pyogenes) från de där de ofarligare bakterierna (H. influenzae och M. catarrhalis) var etiologiskt agens. Däremot kunde inte halten av cytokinet IL-6 i blod korreleras till vilken bakterie som orsakat den aktuella AOM:en.
I det avslutande femte arbetet undersöktes 82 patienter med AOM. Härvid gjordes öronmikroskopi samt bakterieodling från mellanörat och nässvalget. Utifrån trumhinnans utseende angav undersökaren troligt etiologiskt agens och detta jämfördes sedan med resultatet av bakterieodlingarna. Av 63 bedömbara patienter kunder man hos 47 ange om infektionen orsakats av komplikationsbenägna bakterier eller sådana med mindre benägenhet för detta.
Sammanfattningsvis har avhandlingen visat att förebyggande antibiotikabehandling vid ÖLI hos otitbenägna barn minskar frekvensen AOM hos äldre barn men ej hos yngre. Upprepade behandling med PcV orsakar inte någon typ av resistensutveckling hos de vid AOM aktuella bakterierna. Det finns dessutom en klar möjlighet att enbart utifrån trumhinnebilden, både vid djurexperimentell och human otit, avgöra om komplikationsbenägna bakterier (S. pneumoniae/S. pyogenes) eller ofarligare sådana (H. influenzae/M. catarrhalis) är etiologiskt agens. Det senare kan resultera i att man i den kliniska situationen ibland kan avvakta med antibiotikabehandling även vid AOM. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/547376
- author
- Foglé-Hansson, Margaretha LU
- supervisor
- opponent
-
- Professor Bagger-Sjöbäck, Dan, Karoliska Institutet, Stockholm
- organization
- publishing date
- 2006
- type
- Thesis
- publication status
- published
- subject
- keywords
- diagnosis, Acute otitis media, Infections, prophylaxis, Infektioner, Otorhinolaryngology, auditive system and speech, audiology, Otorinolaryngologi, audiologi, hörsel- och talorganen
- pages
- 96 pages
- publisher
- Foglé-Hansson, Margaretha
- defense location
- Lundmarksalen, Astronomiska huset, Lunds Universitet
- defense date
- 2006-11-02 13:00:00
- ISBN
- 91-85559-54-7
- language
- English
- LU publication?
- yes
- additional info
- K Prellner, M Foglé-Hansson, F Jörgensen, O Kalm and C Kamme. 1994. Prevention of Recurrent Acute Otitis Media in Otitis-prone Children by Intermittent Prophylaxis with Penicillin. Acta Otolaryngol, vol 114 pp 182-187.M Foglé-Hansson, P White, A Hermansson and K Prellner. 2001. Short-term penicillin-V prophylaxis did not prevent acute otitis media in infants. Int J Pediatr Otorhinolaryngol, vol 59 pp 119-123.M Foglé-Hansson, P White and A Hermansson. 2003. Pathogens in acute otitis media – impact of intermittent penicillin V prophylaxis on infant nasopharyngeal flora. Int J Pediatr Otorhinolaryngol, vol 67 pp 511-516.M Foglé-Hansson, P White, A Hermansson and Å Melhus. 2006. Otomicroscopic findings and systemic interleukin-6 levels in relation to etiologic agent during experimental acute otitis media. APMIS, vol 114 pp 285-291.M Foglé-Hansson, P White and A Hermansson. . Prediction of upper respiratory tract bacteria in acute otitis media in children. (submitted)
- id
- 0282b177-54ab-4fec-9480-fcd770768cd2 (old id 547376)
- date added to LUP
- 2016-04-01 17:05:06
- date last changed
- 2018-11-21 20:46:31
@phdthesis{0282b177-54ab-4fec-9480-fcd770768cd2, abstract = {{Acute otitis media (AOM) is one of the most common childhood diseases and the most common causes of antibiotic treatment in small children. Most children will experience one or two episodes of AOM during preschool age but some will suffer from repeated attacks, they will become otitis-prone. Complications with severe, sometimes fatal infections such as acute mastoiditis and meningitis are nowadays rare but does still exist.<br/><br> <br/><br> The major pathogens found in AOM are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. During the last decades all these common upper airway bacteria have developed various degrees of resistance against antibiotics. Several studies have related these problems to a large consumption of antibiotics especially in small children. It is of great interest to reduce the antibiotic consumption in these small children without raising the number of serious complications.<br/><br> <br/><br> In the first two studies intermittent antibiotic prophylaxis at upper respiratory tract infections (URTI) was tested as a method of reducing the number of AOM episodes in small otitis prone children. Long time prophylaxis with antibiotics have been shown to be effective but raises the antibiotic consumption very much. The prophylactic model studied here was treatment with a short-term penicillin V course of 5 days at episodes of URTI. It was shown that this seemed effective in the slightly older patients in the first study but that this method was not effective in the younger truly otitis prone children. The children in this study were treated with large quantities of pcV during the study period of one year, but there was no change in the upper airway bacteria regarding the susceptibility to betalactams in the S. pneumoniae or the ?-laktamase-production in the H. influenzae.<br/><br> <br/><br> Most complications in AOM are caused by the gram+ bacteria while most AOM caused by gram- bacteria will heal without treatment. If we could differentiate the potentially dangerous bacteria from the more harmless ones at the diagnostic moment we might be able to chose treatment more judiciously and thus lower the number of antibiotic treatments without raising the number of complications. An experimental study showed that we were able to predict the type of bacteria responsible for the infection regarding gram-positive (S. pneumoniae and S. pyogenes) and gram-negative bacteria (H. influenzae and M. catarrhalis). The same was possible in humans studied at the ENT department in Skövde during optimal conditions.<br/><br> <br/><br> In summary; prophylaxis at URTI in children with penicillin V in a short-term period did not reduce the amount of episodes of AOM in the younger truly otitis-prone children. The antibiotic susceptibility for penicillin in the S. pneumoniae during these repetitive courses of pcV did not change and the H. influenzae did not produce more ?-laktamase.<br/><br> <br/><br> It was possible to predict whether a gram+ or gram ? bacteria was the causing pathogen in an experimental and a human setting which further emphasises the need of better diagnosis in AOM.}}, author = {{Foglé-Hansson, Margaretha}}, isbn = {{91-85559-54-7}}, keywords = {{diagnosis; Acute otitis media; Infections; prophylaxis; Infektioner; Otorhinolaryngology; auditive system and speech; audiology; Otorinolaryngologi; audiologi; hörsel- och talorganen}}, language = {{eng}}, publisher = {{Foglé-Hansson, Margaretha}}, school = {{Lund University}}, title = {{Acute Otitis Media. Aspects of diagnosis and prophylaxis}}, url = {{https://lup.lub.lu.se/search/files/4869889/547378.pdf}}, year = {{2006}}, }