First Episode Of Acute Otitis Media Research Articles

The effect of pneumococcal conjugated vaccines on occurrence of recurrent acute otitis media among infants diagnosed with acute otitis media at an age younger than 2months.

To examine the impact of pneumococcal conjugate vaccines (PCV) on the occurrence of recurrent acute otitis media (rAOM) among infants diagnosed with an early acute otitis media (AOM) episode. Retrospective cohort study of pediatric patients with a first episode of AOM at an age < 2months. Data included clinical, demographic, and microbiological findings at the first AOM episode. In addition, a 5-year follow-up after the patient's first episode was completed from the medical records. This information included documentation of rAOM episodes and complications of AOM (hearing loss, speech disturbance, mastoiditis, and tympanic membrane perforation) and of ear-related surgical procedures (ventilation tube placement, adenoidectomies, and mastoid surgery). Two groups were studied: patients diagnosed between 2005 and 2009 (representing the unvaccinated group, group 1) and those diagnosed in 2010-2014 (the vaccinated group, group 2). A total of 170 infants were diagnosed with a first AOM episode at an age < 2months; 81 of them belonged to group 1 and 89 to group 2. Streptococcus pneumoniae was isolated in the middle-ear fluid in the first AOM episode in 48.1% of the patients in group 1 and in 30.3% in group 2 (P = 0.0316). 49/81 (60.5%) infants in group 1 were diagnosed with rAOM versus 39/80 (43.8%) in group 2 (P = 0.0298). No statistical differences were found between the groups with respect to long-term complications or need for surgery later in life. Conclusion: Our study showed a significant decrease in the occurrence of rAOM in infants diagnosed with AOM during the first 2months of life and timely immunized with PCVs following this initial AOM episode. What is Known: • 30% of children experience recurrent AOM (rAOM) at the first year of life. The earlier the age of the first AOM, the greater the risk for future complications. • After the introduction of PCVs, the overall pneumococcal AOM incidence declined. We investigated the future effect of PCVs on rAOM occurrence, when administered after the first AOM episode. What is New: • A retrospective cohort of 170 infants with a first AOM episode at an age <2 months and followed for 5 years, showed a significant decrease (28.0%) of rAOM in immunized infants following the initial AOM episode. • Our findings supplement previous data suggesting that the widespread PCVs use prevents rAOM by preventing early AOM and emphasize the importance of timely administration of the PCVs.

4471 Interactions of the Infant Nasopharyngeal Microbiota and Subjects’ Clinical Traits in Development of Viral Upper Respiratory Tract Infections and Acute Otitis Media

OBJECTIVES/GOALS: Identify the interactions between nasopharyngeal bacterial pathogens, commensals, and patient clinical characteristics in relation to the development of viral upper respiratory tract infections (URI) and acute otitis media (AOM) in infants. METHODS/STUDY POPULATION: The subjects were part of a prospective, longitudinal study (2008–2014) of infants to evaluate the prevalence and risks for the development of URI and AOM. Healthy infants (n = 362) were enrolled from near birth and followed to the first episode of AOM up to 12 months of age. Nasopharyngeal specimens and clinical traits were collected at monthly intervals between 1-6 months, month 9, and during viral URI episodes. Subjects were closely followed for AOM development. 16S rRNA sequencing was performed on the nasopharyngeal swabs to identify their bacterial composition. Multidimensional (2, 3, and 4 dimensional) co-presence, co-exclusion, and one-way relation patterns were identified between the microbiome compositions, health status, and other collected clinical traits. RESULTS/ANTICIPATED RESULTS: We analyzed 971 specimens collected monthly and during URI and AOM episodes from 139 infants. Of the 139 enrolled subjects, 96% had 2 or more healthy samples, 77% contracted URI/AOM during the study period, and 60% had at least 1 healthy sample before URI/AOM onset. Otopathogens (Moraxella, Haemophilus, and Streptococcus), Staphylococcus, and Pseudomonas were the most common pathogenic genera. Corynebacterium, Dolosigranulum, and Acinetobacter were 3 most abundant commensal bacterial genera. Samples from infants with AOM in the first year had a significantly higher relative abundance of Haemophilus, Enterobacter, and Yersinia, and lower relative abundance of Corynebacterium, and Pseudomonas compared to samples from infants who did not develop AOM. DISCUSSION/SIGNIFICANCE OF IMPACT: Identification of complex multidimensional interaction patterns within microbial communities and environmental factors is vital to understanding disease onset risk and prevention. Prophylactic microbiome and environmental factor modulation between enterotypes could be used to reduce URI/AOM onset in infants.

Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Prevention.

In recent years, new information has been acquired regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society, therefore, decided to issue an update to the Italian Pediatric Society guidelines published in 2010. The search was conducted on Pubmed, and only those studies regarding the pediatric age alone, in English or Italian, published between January 1, 2010 and December 31, 2018, were included. Each study included in the review was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The quality of the systematic reviews was evaluated using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts. The importance of eliminating risk factors (passive smoking, environmental pollution, use of pacifier, obesity, limitation of day-care center attendance) and the promotion of breastfeeding and hygiene practices (nasal lavages) was confirmed. The importance of pneumococcal vaccination in the prevention of AOM was reiterated with regard to the prevention of both the first episode of AOM and recurrences. Grommets can be inserted in selected cases of recurrent AOM that did not respond to all other prevention strategies. Antibiotic prophylaxis is not recommended for the prevention of recurrent AOM, except in certain carefully selected cases. The use of complementary therapies, probiotics, xylitol and vitamin D is not recommended. The prevention of episodes of AOM requires the elimination of risk factors and pneumococcal and influenza vaccination. The use of other products such as probiotics and vitamin D is not supported by adequate evidence.

Acute Otitis Media and Other Complications of Viral Respiratory Infection.

Viral upper and lower respiratory tract infections (URI, LRI) are common in infants. We determined the prevalence of viral URI and its complications, including acute otitis media (AOM) and LRI, and assessed the effect of bacterial-viral interactions, and genetic and environmental risks on AOM development. Healthy infants were enrolled from near birth and followed to the first episode of AOM up to 12 months of age. Nasopharyngeal specimens were collected at monthly intervals (months 1-6, 9) and during viral URI episodes for bacterial culture and viral polymerase chain reaction studies. Subjects were followed closely for AOM development. A total of 367 infants were followed for 286 child-years; 887 URI (305 infants) and 180 AOM episodes (143 infants) were documented. Prevalence of URI, LRI, and AOM in the first year was 3.2, 0.25, and 0.67 per child-year, respectively. Cumulative AOM incidence by ages 3, 6, and 12 months was 6%, 23%, and 46%. Infants with and without AOM had 4.7 and 2.3 URI episodes per child-year, respectively (P < .002). Pathogenic bacterial colonization rates by month were significantly higher in infants with AOM (P < .005). Breastfeeding reduced both URI and AOM risks (P < .05). Significant bacterial-viral interactions occurred with Moraxella catarrhalis and a variety of respiratory viruses and altered URI and AOM risks. Almost half of infants experienced AOM by age 1. Important AOM risk factors included frequent viral URI, pathogenic bacterial colonization, and lack of breastfeeding. Bacterial-viral interactions may play a significant role in AOM pathogenesis and deserve further investigation.

Upper Respiratory Infection and Acute Otitis Media Common in Infancy

Researchers investigated the prevalence of viral respiratory infections and acute otitis media (AOM) in a prospective cohort of 367 healthy infants born between 2008 and 2014 in Texas. Infants were closely followed until the first episode of AOM or up to 12 months; 311 (85%) completed the study. Nasopharyngeal swabs were obtained for bacterial culture and viral …

Macrolide resistance in Streptococcus pneumoniae isolated from Argentinian pediatric patients suffering from acute otitis media

Macrolide-resistant Streptococcus pneumoniae emerged in Argentina in 1995, representing 26% of invasive infection isolates in children under 5 years old. The objectives of this study were to describe the prevalence of ermB and mefA genes in macrolide-resistant S. pneumoniae isolates from acute otitis media (AOM) and to determine their genetic relatedness. Between May 2009 and August 2010, 126 S. pneumoniae isolates from 324 otherwise healthy children with a first episode of AOM were included. Twenty six of these isolates (20.6%) were resistant to erythromycin. Most frequent serotypes were: 14 (46.2%), 6A (23.1%), 19F (7.7%) and 9V (7.7%). Twenty (76.9%) carried the mefA gene, 5 (19.2%) have the ermB gene, and 1 (3.9%) both ermB + mefA. Ten clonal types were identified, mostly related to Sweden15A-25/ST782 (SLV63), CloneB6A/ST473 and England14-9/ ST9. This is the first study assessing the mechanisms of macrolide resistance in pneumococci isolates from pediatric AOM in Argentina and their genetic relatedness.

Implementing the Delayed Antibiotic Therapy Approach Significantly Reduced Antibiotics Consumption in Israeli Children With First Documented Acute Otitis Media

In 2004, the Israel Medical Association issued guidelines recommending delaying antibiotic therapy for non severe acute otitis media(AOM) in children aged > or = 6 months for 24 to 48 hours, using analgesics for symptomatic relief instead. We assessed the effect of these guidelines on antibiotic use associated with AOM in an Israeli health maintenance organization. We conducted a retrospective study of pharmacy purchasing and physician visit data between the years 2002 and 2007. The study population included children aged 6 months to 5 years who were diagnosed with a first episode of AOM and had not been treated with antibiotics within the proceeding month. For each calendar year data we analyzed the following:(1) annual incidence of first episode of AOM, (2) rate of antibiotic treatment, and (3) rate of topical treatment for pain relief. Comparisons were made among the years for the total population and for age groups 0.5 to 1, 1 to 2, and 2 to 5 years. The eligible study population ranged from 154,961 children in 2002 to 158,971 in 2007. Between 2002 and 2004, the rate of antibiotic treatment for first documented AOM increased from 53% to 61% in children aged 6 months to 1 year, 56% to 63% among children aged 1 to 2 years, and 51% to 56% of children aged 2 to 5 years (P < 0.001). Between 2004 and 2007, treatment rates decreased from 61% to 54%, 63% to 54%, and 56% to 47%, respectively(P < 0.001). Proportions of cases treated exclusively with topical therapy increased between 2004 and 2007 from 5% to 9%, 4% to 8%, and 8 to 14%for the respective categories (P < 0.001). Implementation of the delayed antibiotic treatment approach was associated with a significant reduction in use of antibiotics associated with first documented AOM in children aged 6 months to 5 years, reversing an upward trend that occurred previously.

Acute otitis media in the first two months of life: characteristics and diagnostic difficulties

Objective:To assess the clinical and laboratory features of acute otitis media (AOM) in infants younger than 2 months, to look for factors predicting bacterial otitis, and to evaluate the accuracy...

What is new in otitis media?

The “wait and see” approach in acute otitis media (AOM), consisting of postponing the antibiotic administration for a few days, has been advocated mainly to counteract the increased bacterial resistance in respiratory infections. This approach is not justified in children less than 2 years of age and this for several reasons. First, AOM is an acute inflammation of the middle ear caused in about 70% of cases by bacteria. Redness and bulging of the tympanic membrane are characteristic findings in bacterial AOM. Second, AOM is associated with long-term dysfunction of the inflamed eustachian tube (ET), particularly in children less than 2 years of age. In this age group, the small calibre of the ET together with its horizontal direction result in impaired clearance, ventilation and protection of the middle ear. Third, recent prospective studies have shown poor long-term prognosis of AOM in children below 2 years with at least 50% of recurrences and persisting otitis media with effusion (OME) in about 35% 6 months after AOM. Viruses elicit AOM in about 30% of children. A prolonged course of AOM has been observed when bacterial and viral infections are combined because viral infection is also associated with ET dysfunction in young children. Bacterial and viral testing of the nasopharyngeal aspirate is an excellent tool both for initial treatment and recurrence of AOM. Antibiotic treatment of AOM is mandatory in children less than 2 years of age to decrease inflammation in the middle ear but also of the ET particularly during the first episode. The best choice is amoxicillin because of its superior penetration in the middle ear. Streptococci pneumoniae with intermediary bacterial resistance to penicillin are particularly associated with recurrent AOM. Therefore the dosage of amoxicillin should be 90 mg/kg per day in three doses. In recurrent AOM with β-lactamase-producing bacilli, amoxicillin should be associated with clavulanic acid at a dose of 6.4 mg/kg per day. The duration of the treatment is not established yet but 10 days is reasonable for a first episode of AOM. OME may be a precursor initiating AOM but also a complication thereof. OME needs a watchful waiting approach. When associated with deafness for 2–3 months in children over 2 years of age, an antibiotic should be given according to the results of the bacterial resistance in the nasopharyngeal aspirate. The high rate of complications of tympanostomy tube insertion outweighs the beneficial effect on hearing loss. The poor results of this procedure are due to the absence of effects on ET dysfunction. Pneumococcal vaccination has little beneficial effects on recurrent AOM and its use in infants needs further studies. Treatment with amoxicillin is indicated in all children younger than 2 years with a first episode of AOM presenting with redness and bulging of the tympanic membrane. Combined amoxicillin and clavulanic acid should be given in patients with β-lactamase-producing bacteria. The duration of treatment is estimated to be at least 10 days depending on the findings by pneumo-otoscopy and tympanometry. Bacterial and viral testing of the nasopharyngeal aspirate is highly recommended particularly in children in day care centres as well as for regular follow-up. The high recurrence rate is due to the long-lasting dysfunction of the eustachian tube and the immune immaturity of children less than 2 years of age.

Meconium contaminated amniotic fluid and infant otitis media: Is it a risk factor in children surviving aspiration and initial distress of respiration?

Histological studies show that amniotic fluid cellular content (AFCC) causes in the middle ear a foreign body reaction, the extent and severity of which depends upon the massiveness of contamination. We studied how factors related to birth and environment affect proneness to acute otitis media (AOM) in infants born through meconium contaminated amniotic fluid. From the birth records of infants born from 1996 to 2000 a list was made of those born through meconium contaminated amniotic fluid with pulmonary aspiration and tracheal suctioning, followed by treatment in a neonatal intensive care unit. Thirty-seven such children formed the study group, 43 children matching the study cases but born through clear fluids formed the control group. Birth and environmental factors together with the frequency and number of episodes of AOM were analyzed in all, based on a verified questionnaire. In addition, 27 children in the study group and 21 in the control group received a specialist ENT examination, hearing tests and tympanometry. The events at delivery were highly significantly different between the two groups, manifested by the lower Apgar points in the study group (p<0.001) while other birth and environmental factors appeared equalized. The first episode of AOM in the study group came earlier than in the control group and their frequency was significantly higher during the 1st and 2nd year of life and during the entire observation period (p<0.001). Tympanostomy was performed more often in the study group. Tympanometry showed more cases of reduced static admittance and negative pressure than in the control group and hearing was poorer. Cases with compromised delivery through meconium contaminated fluids, resulting in pulmonary aspiration and in need of intensive care treatment, form a risk group, which should be closely followed. Early nasopharyngeal suctioning of AFCC may reduce its entry into the middle ear. A prolonged episode of AOM suggests mucosal involvement of several middle ear compartments, shown by histological studies to occur in all cases of massive contamination. Placement of a ventilation tube after the first prolonged AOM allows regression of the granulation tissue in the air spaces together with the secretory elements in the mucosa.

Acute otitis media in infants less than three months of age: Clinical presentation, etiology and concomitant diseases

Acute otitis media (AOM) in the neonatal period can be difficult to diagnose. This infection can be isolated and localized, or it may be associated with serious bacterial infections or other illnesses. The objectives of this study were to determine the clinical presentation, etiology, susceptibility pattern, and frequency of bacteremia, meningitis and other serious bacterial infections associated with the first episode of AOM in young infants. From July 2002 to August 2004, infants less than 12 weeks of age with confirmed AOM underwent tympanocentesis with culture of the middle ear fluid. Sepsis work-up was performed in all infants, and they were admitted to the pediatric department. Parenteral antibiotic therapy with a combination of ampicillin and gentamicin was initiated. Sixty-eight infants were diagnosed with AOM. The median age was 43+/-17 days, 17 infants (25%) were less than 4 weeks of age. Fever was present in 45 (66%) of the patients. Meningitis or bacteremia was not diagnosed in any of the cases. Concomitant urinary tract infection was diagnosed in six (8.8%) cases and broncholitis in seven (10.4%). Forty-seven bacterial pathogens were isolated from the middle-ear fluid. Streptococcus pneumoniae was the leading pathogen with 18 isolates (38%), followed by non-typable Haemophilus influenzae with nine (19%). Fourteen of the S. pneumoniae (78%) isolates were susceptible to penicillin and the other four (22%) were intermediately resistant. Three (33%) of the nine H. influenzae isolates were beta-lactamase producers. In our study, AOM in infants less than 3 months of age is a localized infection and it is not associated with severe bacterial infections. S. pneumoniae and H. influenzae are the leading pathogens. In our region, most of S. pneumoniae strains are still susceptible to penicillin. Although only small number of patients were under 4 weeks of age, the results of the present study raise the question of whether the current policy of a full sepsis work-up in neonates with AOM is relevant.

Relationship between respiratory syncytial virus infection and acute otitis media in children

Background: Respiratory syncytial virus (RSV) is among the major causes of respiratory tract infection in infants and young children, and concomitant acute otitis media (AOM) often develops. However, there are only a few reports about AOM associated with RSV infection. Methods: Two hundred and thirty children who were diagnosed as having RSV infection were studied by enzyme immunoassay (Testpack RSV®) at the Department of Pediatrics of Tohoku Rosai Hospital from 1 November 2001 to 31 October 2002. In the patients with AOM, bacterial culture and detection of RSV antigen in the middle ear fluid (MEF) by enzyme immunoassay were performed, and the outcome was investigated. Results: Among the 230 children, 120 (52.2%) were found to have AOM. In children under 2 years of age, the incidence of AOM was significantly higher (73.1%) than in the older children (29.7%). RSV antigen was positive in the MEF of 36 out of 52 patients with AOM (69.2%). In 24 of the 46 patients in whom both RSV antigen detection and bacterial culture of MEF were performed, RSV antigen was detected and bacterial culture was negative. Although the outcome of the first episode of AOM following RSV infection was favorable, relapse was observed in 31% of the patients. Conclusion: These results confirm that patients with RSV infection have a high risk of AOM, especially children younger than 2 years of age, and suggest that RSV may be a direct cause of AOM at least in the early stage of infection with this virus. The necessity of performing careful follow-up of AOM after resolution of symptoms is suggested because relapse is common.

Relationship between respiratory syncytial virus infection and acute otitis media in children

Background: Respiratory syncytial virus (RSV) is among the major causes of respiratory tract infection in infants and young children, and concomitant acute otitis media (AOM) often develops. However, there are only a few reports about AOM associated with RSV infection. Methods: Two hundred and thirty children who were diagnosed as having RSV infection were studied by enzyme immunoassay (Testpack RSV ®) at the Department of Pediatrics of Tohoku Rosai Hospital from 1 November 2001 to 31 October 2002. In the patients with AOM, bacterial culture and detection of RSV antigen in the middle ear fluid (MEF) by enzyme immunoassay were performed, and the outcome was investigated. Results: Among the 230 children, 120 (52.2%) were found to have AOM. In children under 2 years of age, the incidence of AOM was significantly higher (73.1%) than in the older children (29.7%). RSV antigen was positive in the MEF of 36 out of 52 patients with AOM (69.2%). In 24 of the 46 patients in whom both RSV antigen detection and bacterial culture of MEF were performed, RSV antigen was detected and bacterial culture was negative. Although the outcome of the first episode of AOM following RSV infection was favorable, relapse was observed in 31% of the patients. Conclusion: These results confirm that patients with RSV infection have a high risk of AOM, especially children younger than 2 years of age, and suggest that RSV may be a direct cause of AOM at least in the early stage of infection with this virus. The necessity of performing careful follow-up of AOM after resolution of symptoms is suggested because relapse is common.

Acute mastoiditis in infancy: the “Soroka” experience: 1990–2000

Acute mastoiditis (AM) is an uncommon but serious complication of acute otitis media (AOM). In the pre-antibiotic era, AM was seen more frequently than it is today, but it was rare in infants. However, in the last two decades an increase in the incidence of AM in infancy has been reported in the literature. During the years 1990-2002, we treated 113 patients with 128 episodes of AM; of them, 24 were infants (median age 6 months; 18 males) who suffered from 26 episodes of AM. Twenty developed AM as a complication of their first episode of AOM. One of the four infants with a prior history of AOM suffered from common variable immunodeficiency. A significant increase in the incidence of AM in infants was recorded during the study period (P = 0.01). The most common presenting clinical signs were post-auricular swelling and fever >38 degrees C (77% and 77%, respectively, of all patients). Seventeen episodes of AM were not treated with prior antibiotics. Tympanocentesis was performed in all episodes of AM. Middle ear fluid culture was positive in 17 (65%) of the 26 AM episodes. The most common pathogens cultured were Streptococcus pneumoniae (10 infants, 58% of all pathogens, 3/10 intermediately susceptible to penicillin) followed by Streptococcus pyogenes (4, 23%), non-typable H. influenzae (2, 12%) and S. aureus (1, 6%). Temporal bone CT showed bone destruction in 14 patients; 3 infants had subperiosteal abscesses and 3 lateral sinus thrombosis. Ten infants underwent mastoid surgery due to non-resolution of symptoms and signs with antibiotic therapy. Eight underwent cortical mastoidectomy with two patients undergoing ventilation tube introduction only. The remainder of the infants healed with conservative treatment. (1) A significant increase in the incidence of AM in infants was recorded over the last decade, though a specific reason for this trend remains uncertain; (2) Most of the cases of AM followed the infant's initial AOM episode, and most of the infants had not received prior antibiotic therapy; (3) The clinical signs and symptoms of AM were more severe in infants than in older patients; (4) While S. pneumonia was the most common pathogen isolated in middle ear fluid cultures, the involvement of S. pyogenes in AM was higher than that reported in AOM.

Restricted use of antibiotic prophylaxis for recurrent acute otitis media in the era of penicillin non-susceptible Streptococcus pneumoniae

Objective/intervention: To compare the annual rates of acute otitis media (AOM) episodes, antibiotic days, and ventilating tube insertion during the first 3 years of life before and after a practice change to restrict use of antibiotic chemoprophylaxis for recurrent AOM. Methods setting: The sole pediatric private practice in a rural Kentucky community. Patients: Population-based sample of all children born consecutively in two different 13 month intervals. Cohort 1 ( n=251) was born before and Cohort 2 ( n=274) was born after restricted use of chemoprophylaxis and documented emergence of widespread penicillin non-susceptible Streptococcus pneumoniae (PNSP). Design: Retrospective case cohort comparison. Main outcome measures: Suppurative AOM diagnosed by validated experienced otoscopists using stringent tympanic membrane criteria. Results: Children were mostly white with the majority (50–65%) enrolled in daycare during each year. The first episode of AOM was experienced by 6 and 12 months of age in 64 and 86%, respectively. Rates of children with recurrent AOM in Cohorts 1 and 2 were 28 and 31% in Year 1, 17 and 23% in Year 2, and 7 and 10% in Year 3, respectively. Rates of new onset AOM and persistent AOM episodes were similar between cohorts in the first 2 years. Number of days of antibiotic prophylaxis were reduced from 11.2 to 3.4 days in Year 1, from 11.9 to 2.6 days in Year 2, and from 6.9 to 0.7 days in Year 3, respectively ( P<0.0001 for each year). Total antibiotic days for Years 1, 2 and 3 were reduced commensurately with prophylactic days from 61.7 to 55.5 days (nonsignificant), from 56.3 to 45.8 days ( P=0.047), and from 38.7 to 25.7 days ( P<0.0001), respectively. For each year a non-significant trend for increased ventilating tube placement from Cohort 1 to Cohort 2, respectively, was observed, 2 versus 2.2%, 4 versus 5.8%, and 0.8 versus 2.6%. Daycare attendance and white race were consistently significant risk factors for AOM and recurrent AOM. Conclusions: in the era of PNSP, restricted use of antibiotic chemoprophylaxis for recurrent AOM was not associated with significantly increased rates of new onset AOM episodes or tube placement in the first 24 months of life. Total antibiotic days were also significantly reduced in Cohort 2 during Years 2 and 3.

Use of diagnostic clusters to assess the economic consequences of rhinopharyngitis in children in Italy and France during the winter

To determine how practitioners diagnose rhinopharyngitis (RP), we conducted a longitudinal, multicenter study of a cohort of 900 children, collecting medical and economic data without interfering with usual medical practice during the winter of 1996–1997 in France and Italy. All ear, nose, and throat (ENT) infections were described clinically; data on the consumption of medical items (physician visits, drug treatment, hospitalization, physiotherapy, preventive treatment, laboratory tests, roentgenograms, and outpatient procedures) were collected to estimate the cost of caring for patients with RP. The mean age of the children was 28.0 months, and the ratio of males to females was approximately 5 to 4. Patients had had a mean 4.1 episodes of RP the previous year and 1.4 episodes of acute otitis media (AOM). There were no marked differences in the children's characteristics between France and Italy. During the winter of the study, this population experienced 4.26 episodes of ENT infection, of which 73.5% were documented at the study sites. Seven homogeneous groups of RP were found, 2 of them each representing < 4% of the overall population. One group presented with otalgia, although the diagnosis of AOM was not recorded by the physician. In 4 groups, the presence of nasal discharge plus cough (without otalgia) was used to make the diagnosis. Medical item consumption varied by country and by group of RP, mainly in the prevailing choice of antibiotics. The difference in duration of treatment was not statistically significant. As a consequence, the costs of caring for patients with RP varied greatly, RP with AOM being the most costly. Last, prognostic factors for costly episodes of infectious ENT were identified. The population at risk included young children who had had AOM episodes during the previous winter, had a first episode of AOM before 6 months of age, had a history of AOM associated with effusion, or attended a community-based child care facility. Therefore, clinical trials aimed at demonstrating cost-effectiveness of prophylaxis should focus on this population.

Acute Otitis Media and Age at Onset among Children in Greenland

This survey examines the age at onset of acute otitis media (AOM) in 591 unselected Greenlandic children aged 3, 4, 5 and 8 years from the two largest towns in Greenland. The attendance rate was 86%. Parental information about episodes of AOM was cross-checked in medical records, which were available for 95% of the children. AOM was defined as episodes with earache, otorrhoea or previous treatment for AOM, with written otoscopic evidence of AOM resulting in treatment with weak analgetics or antibiotics. Recurrent AOM (rAOM) was defined as > or = 5 AOM episodes since birth. In total, 66% of the children had experienced AOM at least once. Of all children, 40% had AOM during the first year of life. Median age of the first episode was 10 months (range: 1-84 months), and there was no sex difference. Children between 7 and 12 months of age were at highest risk of AOM. Children with rAOM had their first AOM episode at a significantly younger age than children with < 5 AOM episodes (median: 7 months, range: 2-48 months). In addition, 83% of children with rAOM had their first AOM episode before 12 months of age compared with 53% of children with < 5 episodes (p < 0.0001). The relative risk of rAOM was eight times greater if the first episode of AOM occurred before six months of age compared to more than 24 months of age. Thirty-five percent of children with rAOM had chronic otitis media as well, compared to only 4% of children with < 5 AOM episodes. We conclude that early onset of AOM (before one year of age) occurs frequently in Greenlandic children compared to others, and a high proportion of these children develop rAOM.

Duration of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae: experiences from the South Swedish Pneumococcal Intervention Project.

As a part of an intervention project, all detected carriers of penicillin-resistant pneumococci (PRP) (MIC, > or = 0.5 mg/L) in Malmöhus County, southern Sweden, were followed by means of weekly nasopharyngeal cultures. The median duration of carriage in 678 individuals was 19 days (range, 3-267 days). The duration of carriage was longest in children < 1 year old (median, 30 days) and shortest in adults > 18 years old (median, 14 days). Index cases, whose cultures were performed during an acute infection, were carriers for a mean of 10 days longer than asymptomatic contact cases (P < .05). The PRP spontaneously disappeared from the nasopharynx within 4 weeks in 68%, within 8 weeks in 87%, and within 12 weeks in 94% of the individuals. Other significant risk factors for prolonged carriage were the occurrence of > 6 episodes of acute otitis media (AOM) or first episode of AOM before the age of 1 year (P < .01), the carriage of PRP by other family members (P < .05), and the obtainment of a first positive culture during the winter months (P < .05).

The occurrence of acute otitis media in infants. A life-table analysis

A random sample of 2512 children were monitored to an average age of two years to determine the occurrence of acute otitis media (AOM). A life-table methodology was employed in the analysis. The cumulative incidence of the first episode of AOM up to 12 months of age was 42.4% (95% confidence interval 40.4–44.4) and the corresponding figure up to 24 months of age was 71.0% (68.9–73.1). The incidence rate for all acute otitis media episodes was 0.93 episodes per child per year (0.90–0.96) during the first 24 months of life increasing in the spring and autumn. The risk of experiencing an episode of acute otitis media increased at the age of 6–12 months and decreased slowly during the second year of life. The results confirm the frequent nature of acute otitis media and stress the necessity for clear, consistent definition of the criteria for acute otitis media in epidemiological research.