Kaj Lundgren

Distribution of diplococcus pneumoniae types in acute otitis media in children and influence of the types on the clinical course in penicillin V therapy

Abstract Pneumococci isolated from the ear exudate in 245 children under 10 years of age afflicted with acute otitis media were typed. Types 3, 6, 14, 18, 19 and 23 were found in 80% of the cases. In the remaining cases, 15 other types were found. Five strains were not typable with the antisera used. Types 14 and 23 were found twice as often in the age group 0-3 years as in the higher age groups, whereas the opposite was true for type 3. The relapse frequency was highest after types 14 and 19 infections. The frequency of residual secretory otitis was highest after type 14 infections. Types 19 and 23 were never found in infections followed by secretory otitis. Patients with type 14 infections, healed or unhealed, showed the same blood group distribution within the ABO and Lewis systems as a normal Swedish population. Penicillin V therapy failed to eliminate the pneumococcal strain from the nasopharynx in 40% of consecutive cases of otitis media. Relapse after penicillin-treated pneumococcal otitis is to be regarded as a new complication of the primary infection and not as a reinfection from the environment.

Penicillin Treatment of Acute Otitis Media in Children

Two hundred and ninety-seven children, aged 6 months to 7 years, with AOM were treated with penicillin V. One hundred and forty-eight children were given 25 or 50 mg/kg body weight twice a day for 5 days, and 149 children 25 mg/kg body weight twice a day for 10 days. No differences were found in the rate of healing between the 5- and 10-day groups. The larger penicillin dose, which was given to half the 5-day group, did not lead to improved healing. Treatment with penicillin for 5 days instead of 10 does not mean any increased risk of complications such as SOM, relapses, or therapeutic failure. Nor does the risk of a recurrence of otitis increase either. The investigation showed that the treatment of AOM with penicillin for 10 days, which is the rule in Sweden, can be reduced to 5 days with maintained satisfactory healing and without risk of increasing the number of complications.

Acute Otitis Media in Sweden

SummaryThe occurrence of Branhamella catarrhalis in the nasopharynx and middle ear exudate was investigated in 3 studies. Bacteria were isolated from the nasopharynx in 63% of 180 healthy children and B. catarrhalis, the most common bacterium present, was isolated in 36%. In 75 children with primary acute otitis media, bacteria were isolated from the nasopharynx in 98% and from the middle ear exudate in 80%. B. catarrhalis was found in the nasopharynx in 43% and in the middle ear exudate in pure culture in 9%. In those children in whom B. catarrhalis was isolated from the middle ear exudate it was also present in the nasopharynx. In 420 children, 338 with primary acute otitis media and 82 who relapsed or did not respond to previous antibiotic therapy, B. catarrhalis was isolated from the nasopharynx in approximately 50%. About half of the B. catarrhalis strains were β-lactamase-producing and the majority of these strains were isolated in children under 3 years of age. Of children with primary acute otitis media who had β-lactamase-producing B. catarrhalis about 50% had not previously received antibiotic treatment.B. catarrhalis is commonly found in the nasopharynx of healthy children as well as in children with acute otitis media. Many of the strains are β-lactamase-producing though many of the children have not been previously treated with antibiotics. In middle ear exudate, B. catarrhalis is found in about 10% of cases. The present incidence of β-lactamase production in B. catarrhalis has not necessitated a change from the choice of penicillin V as the first-line drug in the treatment of acute otitis media in children in Sweden. Penicillin V 50 mg/kg bodyweight/day is administered on a twice daily schedule for 5 days. Antibiotics with a broader spectrum are reserved for those cases which do not resolve following treatment with penicillin V.

Epidemiology of Acute Otitis Media in Children in An Urban Population

The epidemiology of acute otItIs media (AOM) in children is still to a great deal inadequately explored ( Hinchcliffe , 1972; McEldowney and Kessner , 1972; Manning et al ., 1974). Most earlier studies have been carried out in small selected groups of children. A few great incidence studies over I year have been published earlier (Medical Research Council, 1957; Pukander , 1982). There are very few cohort studies penetrating the relationship between AOM and demographic, medical and socio-economic factors ( Pukander , 1982; Paterson and MacLean , 1970; Teele et al ., 1980). Prospective investigations in a sufficiently large cohort of unselected children from a weel-defined population have been recommended ( Kudrjavcev and Schoenberg , 1979). Malmo, Sweden, is a well-defined geographic unit with unique conditions for epidemiologic studies. The aim of the present investigation was to study the incidence rate of AOM in children in a prospective cohort study with a special reference to children with recurrent episodes of AOM early in life.

A Prospective Study of Acute Otitis Media in Children: 2. Incidence in An Urban Population

Since 1977 a cohort study on the incidence of acute otitis media (AOM) is going on in Malmo, Sweden. The study includes 8 900 children born in 1977–1980. The maximum time of observation was 48 months. Children, aged 6–11 months, run the greatest risk of getting AOM. 54% of the children born in 1977 had at least one episode before the age of 48 months and 48% of these children had more than one episode. There was no difference with sex, but the boys had significantly higher cumulative incidence rate (CIR) than the girls. Recurrent episodes were significantly higher in children having their first episode before the age of 18 months. The CIR of AOM was higher among children in a modern villa suburb compared to those in a modern apartment-house district or in the centre of the city. Children at day-care centers run a greater risk of getting recurrent AOM than those at home or in family day-care homes.

Amoxycillin/Clavulanate versus Amoxycillin in Recurrent Otitis Media and Therapeutic Failure in Children

A total of 102 children with recurrent otitis media or therapeutic failure after treatment with phenoxymethyl penicillin were entered into a double-blind study with parallel groups, comparing treatment with amoxycillin/clavulanate suspension (Spektramox) for 7 days with amoxycillin suspension (Imacillin) for 10 days. Bacterial and clinical investigations were performed. A total of 91 patients were evaluated for efficacy at the first follow-up visit (10-12 days after start of treatment). Amoxycillin/clavulanate and amoxycillin showed equally high, satisfactory treatment results, i.e. more than a 90% response. Similarly, there was no statistically significant difference between the treatment groups at the second follow-up visit (about 30 days after start of treatment). Bacteriological cultures from the nasopharynx showed equal distribution of Haemophilus influenzae, Branhamella catarrhalis and Streptococcus pneumoniae between the study groups. Elimination of the initially occurring pathogens was equal in the two study groups with the exception of B. catarrhalis which was eliminated to a significantly higher extent with amoxycillin/clavulanate. Both drugs were well tolerated. In patients with recurrent otitis media or therapeutic failure, treatment with amoxycillin/clavulanate for 7 days results in high, satisfactory clinical effects and is comparable to treatment with amoxycillin for 10 days.

A Prospective Study of Acute Otitis Media in Children: 1. Design, Method and Material

Since 1977 diagnosed attacks of acute otitis media (AOM) in children living in Malmo, Sweden, have been registered in a prospective longitudinal epidemiologic study. The study is planned to continue for about 10 years. The registration includes date of birth and date and place of diagnosis in 6 932 children with AOM as well as official data on the patients dwelling and type of day-care within the city. In 1977 all children up to 3 years of age were registered. In each of the following 2 years a new age class was included. Since 1980 children up to 15 years have been registered. The disease was most common among one-year-olds, 29% had at least one episode during 1980. The occurrence did not vary with sex. AOM was most common during the winter season. Children living in a modern villa suburb had AOM more often than those living in the centre of the city. The occurrence of AOM was highest among children in day-care centers.

Aspects on Antibiotic Treatment of Acute Otitis Media

The antibiotic treatment of acute otitis media (AOM) in children has always been a matter of much discussion and great controversy. Many studies have been devoted to the effect of treatment with different drugs or combinations of drugs. Most authors seem to agree on the suitability of antibiotics, but opinions differ as to the most appropriate antibiotic or combination of antibiotics.