Transcript Acute Otitis Media To treat or not to treat

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
Netherlands vs Australia
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
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
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)
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
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
High dose amoxycillin
Co-amoxyclav
Cephalosporin
Shorter courses?
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
Prevention
Smoking
 Crèche
 Vaccination – pneumococcal and flu
 Antibiotic prophylaxis
 Grommets
 Adenoidectomy
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