Acute Otitis Media Infections Research Articles

Changes in antimicrobial resistance in acute otitis media and otitis externa.

Acute otitis media (AOM) and otitis externa (OE) are common ear infections which may warrant antibiotic therapy. For many infections, there is a rise in antimicrobial resistance, which is associated with treatment failure, morbidity, prolonged hospitalisation and mortality. This study aimed to identify longitudinal changes in microbiology and antimicrobial resistance in aural swabs taken from patients with AOM or OE. Retrospective observational analysis. Aural samples processed at Manchester Medical Microbiology Partnership Laboratories between January 2008 and December 2018 were analysed to record organism isolated and antimicrobial sensitivity. Individual aural swabs from 7200 patients. Changes in the incidence of organisms and antimicrobial resistance between two time periods (2008-2012 and 2013-2018) were compared using the chi-squared test (alpha = 0.05). From 7200 swabs, 2879 (40%) were from children. The most frequently isolated organisms were Staphylococcus aureus (25%), Pseudomonas aeruginosa (24.4%), yeast (9.1%), mixed anaerobes (7.9%) and Haemophilus influenzae (6.1%). In children aged 0-4 years, H. influenzae had particularly high incidence (25%). Overall, the incidence of P. aeruginosa decreased significantly with time (p = 0.05). Isolates displaying resistance to one or more antimicrobial agents increased significantly in number in the second time period for P. aeruginosa (p = 0.04) and H. influenzae (p = 0.03). There was increased resistance to amoxicillin for P. aeruginosa (p = 0.01) and to erythromycin for H. influenzae (p < 0.01). Variations in type and frequency of organisms with increasing age likely result from differences in the preponderance of AOM compared to OE in children versus adults. We found increasing antimicrobial resistance for two organisms commonly isolated from AOM and OE infections, suggesting that aspects of current UK treatment practices and national recommendations may need to be revised.

National Amoxicillin-Clavulanate Formulation Use Pattern: A Survey.

Five commercially available amoxicillin-clavulanate (AMC) ratio formulations contribute to ratio selection variability with efficacy and toxicity implications. The objective of this survey was to determine AMC formulation use patterns across the United States. A multicenter practitioner survey was distributed to multiple listservs (American College of Clinical Pharmacy pediatrics, infectious diseases, ambulatory care, pharmacy administration; American Society of Health-System Pharmacists; Pediatric Pharmacy Association members), and selected pediatric Vizient members in June 2019. Responses were screened for multiples within institutions. Repeated organization responses were identified (n = 37) and excluded if the duplicate matched another response from the same organization exactly (n = 0). One hundred ninety independent responses were received. Nearly 62% of respondents represented a children's hospital within an acute care hospital; remainder being from stand-alone children's hospitals. Around 55% of respondents indicated prescribers were responsible for choosing the patient-specific formulation for inpatients. Nearly 70% of respondents indicated multiple formulations were available due to clinical need (efficacy, toxicity, measurable volume), whereas over 40% responded that the number of liquid formulations were limited to decrease the potential for error. Variability was demonstrated among institutions using ≥ 2 different formulations for acute otitis media (AOM), sinusitis, lower respiratory tract infection, skin and soft tissue infection, and urinary tract infection (33.6%, 37.3%, 41.5%, 35.8%, and 35.8%, respectively). The 14:1 formulation was the most common, but not exclusive, for AOM, sinusitis, and lower respiratory tract infections with 2.1%, 2.1%, and 2.6% of respondents indicating use of the 2:1 formulation and 10.9%, 15%, and 16.6% of respondents indicating use of the 4:1 formulation. Significant AMC formulation selection variability exists across the United States.

Hearing loss after bacterial meningitis, a retrospective study

Background Hearing loss is a common sequela after bacterial meningitis, but risk factors for this are poorly studied, particularly in relation to concurrent acute otitis media (AOM). Aims The aim of this study was to investigate incidence and risk factors for hearing loss in patients treated for bacterial meningitis. Methods In this retrospective study, medical records for patients admitted to hospital with bacterial meningitis in Skåne county, Sweden, between 2000 and 2017 were retrieved. The association between risk factors and hearing loss was estimated using logistic regression. Results During the 18 years, 187 cases of meningitis were identified. Hearing loss was confirmed in 71 of the 119 patients who had done an audiometry. It was significantly more common in adults. There was also evidence of an association between hearing loss and AOM, and between hearing loss and pneumococcal infection. Conclusion Age, concurrent AOM and pneumococcal infection were risk factors for developing hearing loss. Despite being recommended in the national guidelines, more than a third of the patients had not done a hearing test after recovering from bacterial meningitis. The findings strengthen the demand for prompt ear examination and – if needed – tympanocentesis in meningitis patients.

Cystic fibrosis mutation classes in pediatric otitis media — Fickle or faulty?

PurposeRecent data have challenged the historical paradigm that cystic fibrosis (CF) protects against otitis media (OM). These findings raised questions about the pathogenesis of this ostensible change. In this study our aim is to characterize acute OM (AOM) risk based on CF genotype. MethodsA retrospective chart review was completed at a tertiary care pediatric hospital. Charts of 159 CF patients seen at our facility from 2010 to 2019 were reviewed. Data collected included demographics, AOM infections, cystic fibrosis transmembrane conductance regulator (CFTR) allele mutations, pulmonary exacerbations (PE), and pancreatic insufficiency (PI) status. Mutation alleles were divided into five classes based on CF guidelines, which were further classified as severe (classes I–III) or mild (classes IV–V). Results54% of patients had at least one episode of AOM with a mean of 1.5 episodes of AOM (standard deviation = 2.3). 86% of patients had severe/severe (S/S) alleles and 14% had severe/mild (S/M). S/S patients had significantly more PE (p = .004) and increased rates of PI (p < .001). Of the 131 patients with S/S mutations, 57% had an episode of AOM while only 46% the 22 S/M patients had an AOM episode (p = .357). ConclusionsTo our knowledge this is the first report showing a clinical trend towards increased middle ear disease in patients with severe CFTR mutations. Future prospective studies will be powered to demonstrate whether this trend is statistically significant. Patients with S/S mutations not only have more severe clinical phenotypes but may have additional unexpected complications such as middle ear disease.

Relative Humidity Affects Acute Otitis Media Visits of Preschool Children to the Emergency Department.

The associations between climate variables and diseases such as respiratory infections, influenza, pediatric seizure, and gastroenteritis have been long appreciated. Infection is the main reason for acute otitis media (AOM) incidence. However, few previous studies explored the correlation between climatic parameters and AOM infections. The most important meteorological factors, temperature, relative humidity, and fine particulate matter (PM2.5), were included in this study. We studied the relationship between these meteorological factors and the AOM visits. It was a retrospective cross-sectional study. A linear correlation and a linear regression model were used to explore the AOM visits and meteorological factors. A total of 7075 emergency department visits for AOM were identified. Relative humidity was found an independent risk factor for the AOM visits in preschool children (regression coefficient = -10.841<0, P = .039 < .05), but not in infants and school-age children. Average temperature and PM2.5 were not correlated with AOM visits. Humidity may have a significant inverse impact on the incidence of AOM in preschool-age children.

High-Dose amoxicillin supported with clavulanic acid as empirical therapy in acute otitis media

An increase in the daily dose of amoxicillin from 45 mg/kg to 90 mg/kg was introduced in late 2000 to respond to increasing presence of penicillin-resistant Streptococcus pneumoniae (PRSP) in Acute Otitis Media (AOM) and in other respiratory infections. The basis for this recommendation is a well understood mechanism of resistance among PRSP as well as established safety profile of amoxicillin with known tolerance to high doses. The addition of a standard dose of clavulanic acid provides protection against resistance present in other pathogens involved in AOM and other respiratory infections. A formulation of high dose of amoxicillin with standard dose of clavulanic acid has been developed to meet the increasing needs for efficacy against bacteria with growing antibiotic resistance. While, on the one hand, there is continued empirical use of standard/lower dose of amoxicillin (45 mg/kg/day) or a second- or third-generation cephalosporin in AOM, on the other hand, there is evidence of a rise in intractable cases (relapses or first-line therapy failures). In addition to this, an evolving disease bacteriology and regional variation in antibiotic susceptibility are determinants of clinical outcome in AOM. The current paper discusses the unmet areas and explains rationale behind guideline-directed empirical high-dose amoxicillin supported with clavulanic acid in AOM.

1362. Antibiotic Prescribing for Acute Otitis Media in Commercially Insured Pediatric Patients in the United States

BackgroundOverprescribing of antibiotics to treat conditions that are self-limiting and do not always require antibiotics is a well-recognized concern in pediatric care. The 2013 American Academy of Pediatrics (AAP) acute otitis media (AOM) guidelines reinforced previous recommendations regarding watchful waiting for three days among patients with non-recurrent uncomplicated AOM and provided more explicit diagnostic criteria.MethodsWe conducted a retrospective cohort study using the IBM Marketscan Commercial Claims Research Databases (2008-2018). Pediatric patients 1 to 12 years old were included. We required a primary diagnosis of AOM in an outpatient setting, without AOM or other complicated ear infections within 6 months prior and no other acute infections in the 2 weeks prior to or 1 week after AOM diagnosis. Patients were classified as treated (pharmacy dispensing record of antibiotics within 3 days of diagnosis) or watchful waiting (no treatment or treatment after > 3 days). We used segmented linear regression to examine changes in treatment proportions across the study period.ResultsWe identified 2,640,920 pediatric AOM episodes, of which 2,033,697 (77.0%) were treated within 3 days. The majority of episodes were treated with amoxicillin (51.3%), followed by amoxicillin/clavulanate (15.3%) and cephalosporins (22.0%). Among episodes in the watchful waiting group, 18,793 (3.1%) filled a prescription within 4-7 days of diagnosis. Most patients saw a pediatrician (62.7%). A larger proportion of otolaryngologists adopted watchful waiting approaches compared to other physician types. There was no difference in chronic conditions or regional variation between the two groups. There was no immediate (p=0.31) or gradual change in treatment proportion (p=0.49) after release of the 2013 guidelines.ConclusionMost pediatric patients continue to be treated with antibiotics within three days of AOM diagnosis, reflecting no impact of the 2013 AAP guidelines. Physician specialty but not patient characteristics appear to determine treatment approaches.DisclosuresNicole Smolinski, PharMD, Nothing to disclose

Immunologic dysfunction contributes to the otitis prone condition

Acute Otitis Media (AOM) is a multifactorial disease occurring mostly in young children who are immunologically naïve to AOM pathogens. This review focuses on work from Rochester NY, USA over the past 12 years among young children who had AOM infections microbiologically-confirmed by tympanocentesis, so called “stringently-defined”. Among stringently-defined otitis prone children deficiencies in fundamental immune defense mechanisms have been identified that contribute to the propensity of young children to experience recurrent AOM. Dysfunction in innate immune responses that cause an immunopathological impact in the nasopharynx have been discovered including inadequate proinflammatory cytokine response and poor epithelial cell repair. Adaptive immunity defects in B cell function and immunologic memory resulting in low levels of antibody to otopathogen-specific antigens allows repeated infections. CD4+ and CD8+ T cell function and memory defects significantly contribute. The immune profile of an otitis prone child resembles that of a neonate through the first year of life. Immunologic deficits in otitis prone children cause them to be unusually vulnerable to viral upper respiratory infections and respond inadequately to routine pediatric vaccines.

Association between otitis media infection and failed hearing screenings in children

This study aims to assess prospectively whether there is an association between frequencies of upper respiratory tract infections (URTI) or asthma in early childhood and failed otoacoustic emission (OAE) screenings later in life. There are no clear recommendations for hearing testing following acute otitis media (AOM) infection. This is a retrospective, practice based chart review. Participants from a primary care setting were 517 pre-adolescent and adolescent children (49.9% female) (ages 10–21; mean, 15 y/o), who had presented with at least one specific bacterial URTI (AOM, Group A Streptococcus (GAS) tonsillitis, or Influenza) during childhood. Hearing testing was recorded incidentally at all subsequent routine health care maintenance visits (OAE hearing screen). Simple linear regression analyses were performed using R (v3.4.4). We found that number of episodes of AOM infections strongly correlated with number of failed OAE screenings later in life (F = 76.37; P = <0.001; R2 = 0.1279), while GAS (F = 1.859; P = 0.1733; R2 = 0.0016) or Influenza infection (F = 2.624; P = 0.1059; R2 = 0.0031) were not associated with failed OAE screening. Correlation between number of AOM infections and number of failed OAE screenings was not strengthened by presence of asthma. This study found evidence of an association between childhood history of AOM and failed OAE screenings in adolescence. Since this population may be at a higher risk for developing permanent or fluctuating hearing losses, further studies to clarify indications and timing of standard audiological testing among these children should be considered.

An Interesting Case of Gradenigo Syndrome

ABSTRACTGradenigo syndrome is a rare complication of acute otitis media infections, and early diagnosis and treatment of the condition are imperative. In this report, we present a case of a 22-month-old girl who developed acute, acquired esotropia associated with recurrent episodes of otitis media, which resolved after antibiotic treatment. To our knowledge, our patient is one of the youngest children reported in the literature to present with presumed Gradenigo syndrome and the only case of recurrent episodes of acquired esotropia and concurrent otitis media within the short time span of 1 month. We hope to add new information to the existing literature and to aid in the understanding of the pathophysiology and management of this condition.

Bacterial Profile of Middle Ear Fluid with Recurrent Acute Otitis Media Infection Using Culture Independent 16S rDNA Gene Sequencing

Background Recurrent otitis media is one of the common infections of childhood. The causative bacterial pathogen is one of the major risk factors of recurrent infection. With limited availability of Indian data, we performed this study to identify the bacterial pathogens. Materials and Methods Otitis media cases were diagnosed based on clinical criteria. Thirty-six middle ear fluid (MEF) samples were collected by tympanocentesis and cultured for pathogens. Seventy-eight per cent of the cases had three previous episodes of otitis media in the past 6 months; the remaining 22% had four episodes in the preceding 6 months. At the time of sample collection, all patients were on antibiotic coverage. Genomic DNA was extracted from MEF samples using Qiagen DNA mini Kit. The 16s rDNA polymerase chain reaction (PCR) and quantitative multiplex (qmPCR) for Streptococcus pneumoniae was performed on these samples. Streptococcus pneumoniae–positive samples were serotyped using PCRSeqTyping. Results None of the 36 samples showed growth by conventional culture. The 16s rDNA PCR identified bacterial pathogens in 33 samples. Four samples gave mixed reads. The organisms identified were Neisseria spp. other than Neisseria meningitidis (n = 7), N. meningitidis (n = 8), Lactococcus spp. (n = 5), S. pneumoniae (n = 2), Pseudomonas aeruginosa (n = 2), Haemophilus influenzae (n = 1), Salmonella infantis (n = 1), Staphylococcus epidermidis (n = 1), Staphylococcus auricularis (n = 1), and Streptococcus sp. (n = 1). The qmPCR detected the presence of S. pneumoniae in six samples. PCRSeqTyping was able to identify Serotype 19A in two samples positive for S. pneumoniae. Conclusion The study demonstrates the usefulness of 16s rDNA PCR protocol to identify the bacterial pathogens in MEF by a culture-independent method. Neisseria spp. were the predominant species identified followed by Lactococcus spp. and S. pneumoniae. Detection of pneumococci by 16s rDNA PCR correlated well with qmPCR-based detection and PCRSeqTyping.

Developing an Intranasal Colonization Model for NTHi in Mice

Nontypeable Haeomphilius influenzae (NTHi) is a Gram‐negative pathogenic bacterium that can live as a commensal in the nasopharynx or can be the cause of Acute Otitis Media (AOM). Although there are currently no approved vaccines in the US to protect against NTHi, several NTHi recombinant protein vaccines are currently being studied for their safety and efficacy of protection. To assess the effectiveness of these prototype vaccines, we had to first establish NTHi colonization and AOM infection models in mice. To establish colonization, C57BL/6J mice were intranasally (IN) infected with PR8 (a mouse‐adapted H1N1 virus) prior to IN infecting with NTHi. Several coinfection protocols were tested to optimize NTHi colonization. Bacterial densities were determined at days 3 and 7 post‐NTHi infection by harvesting blood, nasal washes, and ear washes from the infected mice. Using this coinfection strategy, we were successful in developing a robust NTHi nasal colonization model in mice.Support or Funding InformationRochester Institute of Technology Honors Program Summer Fellowship and Rochester General Hospital Research Institute Summer Scholars FundThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Factors affecting the outcome of adenoidectomy in children treated for chronic otitis media with effusion

ObjectiveThe aim of this cohort was to determine potential risk factors, concerning the effectiveness of adenoidectomy in the treatment of chronic otitis media with effusion in children. MethodsNinety six children with chronic otitis media with effusion treated with adenoidectomy were enrolled in this study. A thorough medical history was taken, including family history of otologic disease, parental smoking habits and breast feeding history. Radiographic palatal airway size was measured preoperatively, whereas the presence of allergy was also investigated. All patients were, postoperatively, followed up for a period of two years, in three month intervals. Disease course was classified as “complete remission”, “improvement” or “consistence”, in every postoperative evaluation, according to strictly established criteria. ResultsChildren’s age proved to be a significant factor in the postoperative outcome of adenoidectomy, as a treatment of chronic otitis media with effusion, especially when comparing patients being over and under the fifth year of age. Also, the presence of allergy, family history of otologic disease and palatal airway size, all proved to influence postoperative outcome in a statistical significant way (p<0.05). On the other hand, child’s sex, passive smoking, breast feeding and previous acute otitis media infections did not seem to alter the efficacy of adenoidectomy. ConclusionAdenoidectomy remains a cornerstone in the treatment of chronic otitis media with effusion in children. Results document that young age, presence of allergy predisposition, otologic family history and small palatal airway can be important drawbacks and should be intensively sought for and taken into account, during treatment planning.

Haemophilus influenzae-protein D specific antibody correlate with protection against acute otitis media in young children

BackgroundHaemophilus influenzae (Hi) causes respiratory infections and pathogenesis of this microbe begins in the human nasopharynx (NP). The objective of this study was to assess the correlation of NP colonization-induced serum antibody levels to Hi protein D with risk of acute otitis media (AOM) in children <2 yr. Methods455 sera from 213 children (age 6–24 months old) were collected when they were colonized with Hi and when the children developed AOM. Presence of Hi during AOM was confirmed by culture of middle ear fluid. Quantitative ELISA was used to determine serum IgG against protein D antigen. ResultsAsymptomatic Hi NP colonization reduced the risk of future AOM infections. Higher serum IgG titers against Hi protein D were correlated with reduced future AOM risk. ConclusionColonization by Hi reduces future AOM risk. Higher antibody levels against protein D correlates with lower risk of AOM caused by Hi.

Modeling specific antibody responses to natural immunization to predict a correlate of protection against infection before commencing a clinical vaccine trial

ABSTRACT Background Clinical trials of vaccines for children to prevent acute otitis media (AOM) infections caused by the bacteria Streptococcus pneumonia (Spn) are in Phase I. The objective of this study was to use serum antibody measurements to pneumococcal purified protein candidate antigens that occurred after natural “immunization” to predict a correlate of protection response needed following an injectable vaccine against AOM in children. Methods 590 nasal and serum samples were collected from 129 healthy children at 6, 9, 12, 15, 18, 24 and 30–36 months of age and when the child developed AOM. Middle ear fluid to detect Spn was collected at every episode of AOM. Quantitative ELISA was used to determine serum IgG against 7 Spn vaccine antigens: PspA clade 3, PspA clade 5, PhtD, PhtE, LytB, PcpA and Ply. A correlate of protection (COP) was estimated by regressing AOM events against age adjusted antibody levels induced by nasopharyngeal colonization and AOM infections, using logistic regression and generalized estimating equation methods. Results A significant COP was found for Spn PhtD (p = 0.0015), PhtE (p = 0.00034), LytB (p = 0.004), PcpA (p = 0.002), and Ply (p = 0.007) between higher antibody levels and reduced frequency of AOM. We estimated that a 2-fold higher antibody level in a child than the mean antibody level induced by NP colonization (after adjusting for subject age) to PhtD, LytB, PcpA, PhtE or Ply reduced the risk of AOM by 14–21%, a 4-fold higher level reduced it by 25–38% and a 10-fold higher level reduced it by 39–54%. Conclusion We developed a model to predict the necessary level of serum antibody and fold higher above a threshold to PhtD, PhtE, LytB, PcpA and Ply that would correlate with a reduced likelihood of AOM in children age 6–24 months old if enrolled in a Phase III clinical efficacy trial.

Nasopharyngeal polymicrobial colonization during health, viral upper respiratory infection and upper respiratory bacterial infection

We sought to understand how polymicrobial colonization varies during health, viral upper respiratory infection (URI) and acute upper respiratory bacterial infection to understand differences in infection-prone vs. non-prone patients. Nasopharyngeal (NP) samples were collected from 74 acute otitis media (AOM) infection-prone and 754 non-prone children during 2094 healthy visits, 673 viral URI visits and 631 AOM visits. Three otopathogens Streptococcus pneumoniae (Spn), Nontypeable Haemophilus influenzae (NTHi), and Moraxella catarrhalis (Mcat) were identified by culture. NP colonization rates of multiple otopathogens during health were significantly lower than during viral URI, and during URI they were lower than at onset of upper respiratory bacterial infection in both AOM infection-prone and non-prone children. AOM infection-prone children had higher polymicrobial colonization rates than non-prone children during health, viral URI and AOM. Polymicrobial colonization rates of AOM infection-prone children during health were equivalent to that of non-prone children during viral URI, and during viral URI were equivalent to that of non-prone during AOM infection. Spn colonization was positively associated with NTHi and Mcat colonization during health, but negatively during AOM infection. The infection-prone patients more frequently have multiple potential bacterial pathogens in the NP than the non-prone patients. Polymicrobial interaction in the NP differs during health and at onset of infection.

Correlation of higher antibody levels to pneumococcal proteins with protection from pneumococcal acute otitis media but not protection from nasopharyngeal colonization in young children

ObjectivesWe previously found that nasopharyngeal (NP) colonization by Streptococcus pneumoniae elicits mucosal antibody responses to three protein vaccine candidates: pneumococcal histidine triad protein D (PhtD), pneumococcal choline-binding protein A (PcpA), and detoxified pneumolysin (PlyD1). Here we sought to determine if mucosal antibody levels to the proteins correlated with protection from acute otitis media (AOM) and NP colonization. MethodsA total of 228 NP samples were prospectively collected from 100 healthy infants at 6–24 months of age. Whenever children were diagnosed with AOM, middle ear fluids were collected to confirm the diagnosis by microbiological culture. NP mucosal IgG and IgA were quantified by ELISA. ResultsHigher NP mucosal antibody levels to S. pneumoniae proteins correlated with significantly decreased likelihood of developing AOM caused by S. pneumoniae during 3 to 12 months of subsequent prospective monitoring. Specifically, children who did not experience AOM (n=111samples) caused by S. pneumoniae had two- to five-fold higher mucosal IgG levels to PcpA (all p values <0.01), six- to eight-fold higher IgA to PhtD (all p values <0.05); two- to three-folder higher IgA to PcpA (all p values <0.05), and two- to three-fold higher IgA to PlyD1 (p 0.08, p 0.03 and p 0.08) compared with children who did experience AOM (n=18samples). No association between mucosal antibody levels to the three proteins and NP colonization with S. pneumoniae was found. ConclusionHigher NP mucosal IgG levels to PcpA, and IgA to PhtD, PcpA and PlyD1 correlate with reduced risk of development of S. pneumoniae AOM infection but not with reduced risk of NP colonization in young children.

Randomized controlled trial of juzen-taiho-to in children with recurrent acute otitis media

ObjectiveRecurrent acute otitis media (AOM) in young children is rapidly increasing worldwide. Repeated antibiotic use leads to antibiotic-resistant pathogen development. Complementary and alternative medicine approaches have been suggested as a supplemental treatment option to conventional antimicrobial medicine. This randomized, parallel-group, open-label, non-herbal medicine controlled trial assessed the efficacy of a traditional Japanese herbal medicine, juzen-taiho-to (JTT) for AOM prevention in otitis-prone children. MethodsChildren prone to recurrent AOM aged 6–48 months were recruited from 26 otolaryngology clinics in Japan and received conventional AOM treatment based on Japanese guidelines with or without 2 daily oral doses of JTT (0.10–0.25g/kg/day). The mean number of AOM episodes, coryza episodes, and duration of total antibiotic administration per month were compared during 3-month intervention. ResultsAt least one episode of AOM was diagnosed in 71% of JTT-group and 92% of control participants during follow-up. JTT administration reduced the frequency of AOM episodes by 57% compared with children who received conventional treatment alone (0.61±0.54 vs. 1.07±0.72 AOM instances/month; P=0.005) and also significantly decreased number of coryza episodes (P=0.015) and total antibiotic administration (P=0.024). ConclusionsThis is the first report of recurrent AOM prevention by herbal medication. JTT appears to effectively prevent recurrent AOM in children. Subsequent double-blind studies are needed to confirm the beneficial effects of JTT on recurrent AOM and upper respiratory tract infections.

Modeling Specific Antibody Responses to Natural Immunization to Predict a Correlate of Protection Against Infection Before Commencing a Clinical Vaccine Trial

ABSTRACTBackground: Clinical trials of vaccines for children to prevent acute otitis media (AOM) infections caused by the bacteria Streptococcus pneumonia (Spn) are in Phase I. The objective of this study was to use serum antibody measurements to pneumococcal purified protein candidate antigens that occurred after natural “immunization” to predict a correlate of protection response needed following an injectable vaccine against AOM in children.Methods: 590 nasal and serum samples were collected from 129 healthy children at 6, 9, 12, 15, 18, 24 and 30–36 months of age and when the child developed AOM. Middle ear fluid to detect Spn was collected at every episode of AOM. Quantitative ELISA was used to determine serum IgG against 7 Spn vaccine antigens: PspA clade 3, PspA clade 5, PhtD, PhtE, LytB, PcpA and Ply. A correlate of protection (COP) was estimated by regressing AOM events against age adjusted antibody levels induced by nasopharyngeal colonization and AOM infections, using logistic regression and ge...

Three Serum Cytokine Biomarkers Predict Presence of Acute Otitis Media Infection and Recovery From Relevant Otopathogens

Three Serum Cytokine Biomarkers Predict Presence of Acute Otitis Media Infection and Recovery From Relevant Otopathogens