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Spontaneously draining acute otitis media in children: An observational study of clinical findings, microbiology and clinical course
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Department of Oto-Rhino-Laryngology, Kalmar County Hospital, Kalmar, Sweden.
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Department of Laboratory Medicine, NÄL, Trollhättan, Sweden.
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2011 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 43, no 11-12, 891-898 p.Article in journal (Refereed) Published
Abstract [en]

Conclusion: The study indicates that an active ‘‘wait and see’’ policy during the first 3 days can be justified in most children with otorrhea but antibiotics should be considered in children who initially present with abundant purulent secretion and pulsating eardrum.

Objectives: To study the clinical recovery of acute otitis media (AOM) with otorrhea in children managed initially without antibiotics.

Methods: Children aged 2-16, presenting with AOM and spontaneous otorrhea, were followed. Specimens for bacterial investigations were obtained, and symptoms were registered on daily basis. The main outcome measures were the frequency of patients treated with antibiotics due to persisting AOM within 9 days in relation to clinical and bacteriologic findings and new AOM within 3 months.

Results: Twelve of 71 children who completed the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new AOM after 30 days. A.otitidis was found in 23 samples, S.pneumoniae in 12, S.pyogenes in 6, F.nucleatum in five. M.pneumoniae, C.pneumoniae and F.necrophorum could not be detected Antibiotics were prescribed more extensively to patients with pulsating eardrum and abundant purulent secretion. All patients with presence of S.pyogenes received antibiotics.

Place, publisher, year, edition, pages
Informa Healthcare, 2011. Vol. 43, no 11-12, 891-898 p.
Keyword [en]
AOM, perforation, spontaneous, otorrhea, microbiology, antibiotics, alloicoccus otitidis
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54831DOI: 10.3109/00365548.2011.591820ISI: 000296641500007OAI: oai:DiVA.org:liu-54831DiVA: diva2:310634
Available from: 2010-04-15 Created: 2010-04-15 Last updated: 2017-12-12
In thesis
1. Treatment of Respiratory Tract Infections in Primary Care with special emphasis on Acute Otitis Media
Open this publication in new window or tab >>Treatment of Respiratory Tract Infections in Primary Care with special emphasis on Acute Otitis Media
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: Most respiratory tract infections (RTI) are self-limiting. Despite this, they are associated with high antibiotic prescription rates in general practice in Sweden. The aim of this thesis was to evaluate the management of respiratory tract infections (RTIs) with particular emphasis on acute otitis media (AOM).

Methods: Paper I: A prospective, open, randomized study of 179 children presenting with AOM and performed in primary care. Paper II & III: Study of 6 years data from primary care in Kalmar County on visits for RTI, retrieved from electronic patient records. Paper IV: Observational, clinical study of 71 children presenting with AOM complicated by perforation, without initial use of antibiotics.

Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 85 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1166
Keyword
General practice, respiratory tract infections, acute otitis media, rapid diagnostic tests, CRP, Strep-A, electronic patient records, physician consultations, antibiotic prescription
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54832 (URN)978-91-7393-446-6 (ISBN)
Public defence
2010-04-23, Aulan N2007, Linnéuniversitetet, Kalmar, 09:00 (English)
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Available from: 2010-04-15 Created: 2010-04-15 Last updated: 2010-04-15Bibliographically approved

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Neumark, ThomasBrudin, LarsMölstad, Sigvard

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