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AOM microbiology has changed since PCV7 use
Coker TR. JAMA. 2010; 304:2161-2169.
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Findings on an otoscopic exam are important to accurately diagnose acute otitis media in children, according to researchers from the University of California-Los Angeles and the University of Southern California.
In addition, they found that the microbiology of AOM has changed with the use of 7-valent pneumococcal conjugate vaccine (Prevnar, Wyeth), in which the prevalence of Streptococcus pneumonia has decreased and the prevalence of Haemophilus influenzae has increased.
“Since [the 2004 American Academy of Pediatrics and American Academy of Family Physicians joint practice guidelines] have been adopted, new trials have been published, the PCV7 has become widely used, and clinician practice has changed regarding antibiotic choice for AOM,” the researchers wrote. “In light of these additional studies and practice changes, we conducted a systematic review to support the new AOM practice guidelines.”
The researchers included 135 articles in their meta-analysis: four on diagnosis, six on PCV7-microbiology and 125 on antibiotic treatment. They included articles written in any language and any study that included children aged 4 weeks to 18 years. They included systematic reviews, randomized controlled trials, controlled clinical trials and observational studies.
In the four studies on diagnosis, redness and tympanic membrane bulging on otoscopic exam were associated with an accurate diagnosis. In the studies on PCV7-microbiology, the prevalence of S. pneumonia decreased after PCV7: 33% to 48% vs. 23% to 31% of children with AOM. The prevalence of H. influenzae increased after PCV7: 41% to 43% vs. 56% to 57% of children with AOM.
For antibiotic usage, immediate use of ampicillin or amoxicillin led to higher short-term clinical success, but accompanying this was an increased rate of rash or diarrhea. Two studies showed better clinical success for immediate vs. delayed antibiotics.
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