Association of Clinical Signs and Symptoms with Bacterial Findings in Acute Otitis Media

Abstract

In acute otitis media (AOM), a means of prediction of the bacterial pathogen based on symptoms and signs would be valuable in selecting appropriate antimicrobial treatment. Children in the control arm (n=831) in the Finnish Otitis Media Vaccine Trial were prospectively observed in a study clinic setting from the age of 2 to 24 months. In patients with AOM, myringotomy with aspiration was performed, and middle ear fluid samples were cultured for bacterial pathogens. Symptoms and signs of respiratory infections were thoroughly recorded. Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae were the most common bacterial pathogens. Pneumococcal AOM was associated with more-severe AOM characterized by fever and earache. AOM due to H. influenzae was associated with eye symptoms and findings. Accurate prediction of a bacterial cause of infection based on symptoms and signs of AOM was not possible, but a specific cause was predicted in some situations, with a high probability of applicability to clinical practice.

Ear discharge in children presenting with acute otitis media: observational study from UK general practice

“…However, a number of other trials have explored the effect of induced ear discharge (myringotomy) -they showed worse 24-hour outcome but no difference in 7-day resolution or longer-term outcomes. [18][19][20] The present finding that about 60% of cases have an identifiable bacterial cause is entirely consistent with previously published data, 19 as is the range of bacteria identified, [19][20][21][22] although it was not possible to find any other UK data subsequent to the most recent changes in vaccine policy. No studies suggest that bacterial and viral infection can be distinguished on the basis of clinical presentation without microbiology.…”

“…No studies suggest that bacterial and viral infection can be distinguished on the basis of clinical presentation without microbiology. 21,22 Although one paper suggests that bacterial findings are poorly correlated L Smith, P Ewings, C Smith, et al…”

The Diagnosis and Management of Acute Otitis Media

“…[134][135][136] As for clinical findings in cases with S pneumoniae and nontypeable H influenzae, some studies suggest that signs and symptoms of AOM caused by S pneumoniae may be more severe (fever, severe earache, bulging TM) than those caused by other pathogens. 44,121,137 These findings were refuted by results of the studies that found AOM caused by nontypeable H influenzae to be associated with bilateral AOM and more severe inflammation of the TM. 96 High-dose amoxicillin will yield middle ear fluid levels that exceed the minimum inhibitory concentration (MIC) of all S pneumoniae serotypes that are intermediately resistant to penicillin (penicillin MICs, 0.12-1.0 μg/mL), and many but not all highly resistant serotypes (penicillin MICs, ≥2 μg/mL) for a longer period of the dosing interval and has been shown to improve bacteriologic and clinical efficacy e982 FROM THE AMERICAN ACADEMY OF PEDIATRICS compared with the regular dose.…”

Análisis crítico de un artículo: antibióticos en otitis media aguda, ¿son necesarios?, ¿existe algún subgrupo que se beneficia?

“…En este caso, existe demostración clara que la otorrea es más frecuente en las otitis de origen bacteriano, así como también es más frecuente el aislamiento de bacterias en las muestras timpánicas de menores de 2 años, y en pacientes con compromiso bilateral 10 .…”