Acute Otitis Media in the 21st Century: What Now?
Introduction:
Acute Otitis Media (AOM), by standard definition, is a condition in which the middle ear shows signs and symptoms of acute inflammation occurring in three weeks or less.
Acute Otitis Media is considered to be the most common indication for antibiotic administration in children. Children aged 6-11 months are more susceptible to acute otitis media with a noted decline in occurrence at ages 18-20 months.
The peak incidence is more commonly noted between ages 3-18 months. There were also some reported cases in infants experiencing their first attack shortly after birth, hence are considered to be otitis-prone. Acute otitis media has been more prevalent in boys than girls.
According to a study done by Caro, R. et al., the total prevalence of clinically diagnosed acute otitis media in the Philippines is 9.6%. There is no gender predilection noted, with ages 0-2 having the most occurrence of AOM in the sample. Also a projection from the National Statistics Office in 2010, predicted that 83% will have at least one episode of acute otitis media in the first three years of life. Those in the pediatric age group are more commonly affected.
The World Health Organization included the Philippines among the countries having the highest incidence of chronic otitis media.
Relevance:
In the emergence of rampant use of antibiotics leading to cases of resistance, a definitive diagnosis of acute otitis media whether mild or severe is essential.
With the success of the pneumococcal conjugate vaccine, (PCV), Center for Disease Control (CDC) has recommended the vaccination of all children below 2 years old and adults 65 years and above leading to positive progress in terms of AOM prevention.
Objectives:
This study aims to impart an understanding of the epidemiology of AOM, its current bacteriology, the use of antibiotics and pneumococcal conjugate vaccine.
Highlights:
Acute Otitis Media prevalence appears to be decreasing concurrently with the usage and development of pneumococcal vaccine. As a result, the administration of vaccine is considered to be a significant aspect of management. Bacteria not covered by this vaccine have now been more commonly known to be causing most cases of AOM.
Another strategy for AOM, that is considered to be safe, diagnostic, and therapeutic is tympanocentesis. However, this may not be the first choice of parents since this is quite an invasive procedure. This entails puncturing of the tympanic membrane allowing the aspiration of fluid from the middle ear cleft.
The best choice for antibiotic therapy for AOM is still uncertain. In a study by Kaur et. al, amoxicillin-clavulanate was used based on bacteriology of middle ear cultures.
There are still no studies that directly compare the use of this broad-spectrum antibiotic with amoxicillin which is recommended in the American Academy of Pediatricians’ (AAP) guideline for most children with AOM.
In a randomized controlled trial, the 5-day regimen of antibiotic therapy with amoxicillin-clavulanate was shown to be inferior to 10-day therapy. Further clinical trials directly evaluating variety of antibiotics and duration of therapy is absolutely of great value to working clinicians in managing AOM in the 21st century.
Conclusion:
Acute Otitis Media is an intricate disease with a number of different factors involved in its epidemiology. Risk factors should also be considered when dealing with AOM.
It is best to be certain with the diagnosis, especially since the AOM diagnostic criteria have become more rigorous over time. This resulted in a decline in the number of AOM incidence as well as the number of otitis-prone children.
The introduction of PCV formulations and increase in its use has been noted to be a key factor in the management of AOM. It can be concluded that epidemiology, rather than risk factors, of AOM had more extensive and notable alterations since the introduction of pneumococcal conjugate vaccines. More importantly, compliance to antibiotic therapy is vital to prevent resistance in treating AOM.
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