From Evidence to Clinical Guidelines in Antibiotic Treatment in Acute Otitis Media in Children.

Elena Lia Spoială,Gabriela Dumitrita Stanciu,Cristina Gavrilovici,Veronica Bild,Daniela Carmen Ababei

doi:10.3390/antibiotics10010052

Elena Lia Spoială, Gabriela Dumitrita Stanciu + Show 3 more

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https://doi.org/10.3390/antibiotics10010052

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Abstract

Acute otitis media (AOM) in children represents a public health concern, being one of the leading causes of health care visits and antibiotic prescriptions worldwide. The overall aim of this paper is to unravel the major current insights into the antibiotic treatment of AOM in children. Our approach is three-fold: 1. a preclinical evaluation of antibiotics in animal models of AOM stressing on the advantages of different species when testing for different schemes of antibiotics; 2. an overview on the new antimicrobial agents whose efficacy has been demonstrated in refractory cases of AOM in children; and 3. an analysis of the different guidelines stressing on the differences and similarities between the various schemes of antibiotic treatment. The preferred therapeutic agents remain amoxicillin and the amoxicillin-clavulanate combination for AOM caused by Streptococcus pneumoniae, whereas oral cephalosporin is preferred in AOM due to Moraxella catarrhalis and Haemophilus influenzae. As for the second and third line antimicrobial treatments, there is a wide variety of suggested antibiotic classes with variations in duration and posology. The decision to prescribe antimicrobial treatment as a first-line choice is based on the severity of the symptoms in 16 of the guidelines included in this review.

Highlights

Acute otitis media (AOM) is a multifactorial disease representing the second most common cause of family physician visits in the pediatric population, following upper respiratory infections [1,2], with a negative economic impact [3]
We will start by presenting a preclinical evaluation of antibiotics in animal models of AOM stressing on the advantages of different species when testing for different schemes of antibiotics
Experimental design induced reproducible pathologic signs similar to those for OME, and Streptococcus pneumoniae was not recovered on or after day 7 suggests that the therapy introduced efficiently sterilized the middle ear cleft; Both effusion cytokine levels (IL-1β, IL-6, IL-10, TNF-α and MIP-2) and mucosal cytokine transcripts (IL-1β, TNF-α, IL-6, IL-10, IFN-γ, TGF-β1, MCP1, IL-8) were much less after antibiotic therapy; The drug decreased the tympanosclerosis severity determined by acute otitis media and myringotomies; Favorable effects on the mucosal changes of the middle ear Piltcher et al [23]; Hebda et al [28]; Genc et al [25]; Ucar et al [37]

Summary

Introduction

Acute otitis media (AOM) is a multifactorial disease representing the second most common cause of family physician visits in the pediatric population, following upper respiratory infections [1,2], with a negative economic impact [3]. The susceptibility to antibiotics among bacteria commonly causing AOM has decreased, the importance of antibiotic therapy cannot be denied [6,7]. Our aim is to unravel the major insights into the antibiotic treatment of AOM in children. We will start by presenting a preclinical evaluation of antibiotics in animal models of AOM stressing on the advantages (characteristics) of different species when testing for different schemes of antibiotics. In the second part of our paper, we will provide an overview on the new antimicrobial agents whose efficacy has been demonstrated in refractory cases of AOM in children. In the last part of the paper, we will analyze the different guidelines for the treatment of AOM in children, stressing on the differences and similarities between the various schemes of antibiotic treatment

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Results

Conclusion