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The Treatment of Acute Otitis Media in Children: III. A Third Clinical Trial

The Treatment of Acute Otitis Media in Children: III. A Third Clinical Trial Abstract THE management of acute otitis media in children varies widely among clinicians and institutions. Points of disagreement include the advisability of myringotomy,1-8 the choice of antimicrobial agents,3,9-13 the effectiveness of antihistamines and decongestants, and the length of treatment. Accurate microbiologic diagnosis is not possible except by needle aspiration of the middle ear cavity through the tympanic membrane,5,8,14 an obviously impractical approach. It was thus decided to evaluate regimens by means of a series of clinical trials, the results of two of which have already been reported.15,16 Because of the danger of complicating mastoiditis and meningitis,3,17-19 we felt that all patients should receive an antimicrobial drug, although we realized that we would thereby probably be treating unnecessarily a number of patients with otitis media related to viral disease. Previous investigations by this group15,16 indicated that sulfonamides are not as effective as tetracyclines in the management References 1. Dixon, J. W.: Acute Otitis Media in Children Treated Without Myringotomy—Follow-Up With Auditometry in 88 Cases , J Laryng 72:227-237 ( (March) ) 1958.Crossref 2. Fry, J.: Antibiotics in Acute Tonsillitis and Acute Otitis Media , Brit Med J 2:883-886 ( (Oct 11) ) 1958.Crossref 3. Hara, H. J.: Otogenic Meningitis in Infancy and Childhood in Antibiotic Era: Observation on 38 Children Treated at Los Angeles County General Hospital From 1950-1957 , Arch Otolaryng 70:315-320 ( (Sept) ) 1959.Crossref 4. Heller, G.: Statistical Study of Otitis Media in Children: II. Antibiotic Era , J Pediat 42:185-188 ( (Feb) ) 1953.Crossref 5. Lahikainen, E. A.: Clinico-Bacteriologic Studies on Acute Otitis Media: Aspiration of Tympanum as Diagnostic and Therapeutic Method , Acta Otolaryng , (suppl 107) , pp 1-82, 1953. 6. Sharp, H. S.: Management of Acute Otitis Media , Brit J Clin Pract 14:279-280 ( (April) ) 1960. 7. Twonsend, E. H., Jr.: Otitis Media in Pediatric Practice , New York J Med 64:1591-1597 ( (June 15) ) 1964. 8. Van Dishoeck, H. A. E.; Derks, A. C. W.; and Voorhorst, R.: Bacteriology and Treatment of Acute Otitis Media in Children , Acta Otolaryng 50:250-261, 1959.Crossref 9. Benson, P. F., and Jelks, M. L.: Trial of Sulfadimethoxine, Long-Acting Sulphonamide, and Penicillin in Acute Otitis Media , J Laryng 75:738-743 ( (Aug) ) 1961.Crossref 10. Handfield-Jones, R. P. C.: Phenethicillin and Penicillin V in Treatment of Acute Otitis Media in Children: Comparative Trial From General Practice , Lancet 1:947-949 ( (May 5) ) 1962. 11. Hodgkins, K.: Streptococcus Pyogenes in Acute Tonsillitis and Otitis Media: Study From General Practice , Lancet 2:514-515 ( (Sept 14) ) 1957.Crossref 12. Medical Research Council: Report of Survey by Medical Research Council's Working-Party for Research in General Practice: Acute Otitis Media in General Practice , Lancet 2:510-514 ( (Sept 14) ) 1957. 13. Schmidt, M. R.: Acute Suppurative Otitis Media in Children Treated With Dipenicillin, Sodium Penicillin, Penicillin Orally, Tetramycin Intramuscularly or Aureomycin , Acta Otolaryng , (suppl 140) , pp 221-231, 1958. 14. Jones, M.: Comparison of Bacteria From Ear and Upper Respiratory Tract in Otitis Media , Arch Otolaryng 72:329-332 ( (Sept) ) 1960.Crossref 15. Stickler, G. B.; Sasano, J. R., Jr.; and McBean, J. B.: Treatment of Acute Otitis Media in Children: Clinical Trial , Clin Pediat 2:534-540 ( (Oct) ) 1963. 16. Stickler, G. B., and McBean, J. B.: Treatment of Acute Otitis Media in Children: II. Second Clinical Trial , JAMA 187:85-89 ( (Jan 11) ) 1964.Crossref 17. Lowe, J. F.; Bamforth, J. S.; and Pracy, R.: Acute Otitis Media: One Year in General Practice , Lancet 2:1129-1132 ( (Nov 30) ) 1963.Crossref 18. McBean, J. B.: Otitic Meningitis: Review of Cases in Attempt to Evaluate Results of Treatment , Arch Otolaryng 64:253-257 ( (Oct) ) 1956.Crossref 19. Van Wormer, D. E.: Autopsy Incidence of Otitis Media in Infants , Wisconsin Med J 62:183-184 ( (April) ) 1963. 20. Heller, G.: Statistical Study of Otitis Media in Children , J Pediat 17:322-330 ( (Sept) ) 1940.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

The Treatment of Acute Otitis Media in Children: III. A Third Clinical Trial

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Publisher
American Medical Association
Copyright
Copyright © 1965 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1965.02090020310008
Publisher site
See Article on Publisher Site

Abstract

Abstract THE management of acute otitis media in children varies widely among clinicians and institutions. Points of disagreement include the advisability of myringotomy,1-8 the choice of antimicrobial agents,3,9-13 the effectiveness of antihistamines and decongestants, and the length of treatment. Accurate microbiologic diagnosis is not possible except by needle aspiration of the middle ear cavity through the tympanic membrane,5,8,14 an obviously impractical approach. It was thus decided to evaluate regimens by means of a series of clinical trials, the results of two of which have already been reported.15,16 Because of the danger of complicating mastoiditis and meningitis,3,17-19 we felt that all patients should receive an antimicrobial drug, although we realized that we would thereby probably be treating unnecessarily a number of patients with otitis media related to viral disease. Previous investigations by this group15,16 indicated that sulfonamides are not as effective as tetracyclines in the management References 1. Dixon, J. W.: Acute Otitis Media in Children Treated Without Myringotomy—Follow-Up With Auditometry in 88 Cases , J Laryng 72:227-237 ( (March) ) 1958.Crossref 2. Fry, J.: Antibiotics in Acute Tonsillitis and Acute Otitis Media , Brit Med J 2:883-886 ( (Oct 11) ) 1958.Crossref 3. Hara, H. J.: Otogenic Meningitis in Infancy and Childhood in Antibiotic Era: Observation on 38 Children Treated at Los Angeles County General Hospital From 1950-1957 , Arch Otolaryng 70:315-320 ( (Sept) ) 1959.Crossref 4. Heller, G.: Statistical Study of Otitis Media in Children: II. Antibiotic Era , J Pediat 42:185-188 ( (Feb) ) 1953.Crossref 5. Lahikainen, E. A.: Clinico-Bacteriologic Studies on Acute Otitis Media: Aspiration of Tympanum as Diagnostic and Therapeutic Method , Acta Otolaryng , (suppl 107) , pp 1-82, 1953. 6. Sharp, H. S.: Management of Acute Otitis Media , Brit J Clin Pract 14:279-280 ( (April) ) 1960. 7. Twonsend, E. H., Jr.: Otitis Media in Pediatric Practice , New York J Med 64:1591-1597 ( (June 15) ) 1964. 8. Van Dishoeck, H. A. E.; Derks, A. C. W.; and Voorhorst, R.: Bacteriology and Treatment of Acute Otitis Media in Children , Acta Otolaryng 50:250-261, 1959.Crossref 9. Benson, P. F., and Jelks, M. L.: Trial of Sulfadimethoxine, Long-Acting Sulphonamide, and Penicillin in Acute Otitis Media , J Laryng 75:738-743 ( (Aug) ) 1961.Crossref 10. Handfield-Jones, R. P. C.: Phenethicillin and Penicillin V in Treatment of Acute Otitis Media in Children: Comparative Trial From General Practice , Lancet 1:947-949 ( (May 5) ) 1962. 11. Hodgkins, K.: Streptococcus Pyogenes in Acute Tonsillitis and Otitis Media: Study From General Practice , Lancet 2:514-515 ( (Sept 14) ) 1957.Crossref 12. Medical Research Council: Report of Survey by Medical Research Council's Working-Party for Research in General Practice: Acute Otitis Media in General Practice , Lancet 2:510-514 ( (Sept 14) ) 1957. 13. Schmidt, M. R.: Acute Suppurative Otitis Media in Children Treated With Dipenicillin, Sodium Penicillin, Penicillin Orally, Tetramycin Intramuscularly or Aureomycin , Acta Otolaryng , (suppl 140) , pp 221-231, 1958. 14. Jones, M.: Comparison of Bacteria From Ear and Upper Respiratory Tract in Otitis Media , Arch Otolaryng 72:329-332 ( (Sept) ) 1960.Crossref 15. Stickler, G. B.; Sasano, J. R., Jr.; and McBean, J. B.: Treatment of Acute Otitis Media in Children: Clinical Trial , Clin Pediat 2:534-540 ( (Oct) ) 1963. 16. Stickler, G. B., and McBean, J. B.: Treatment of Acute Otitis Media in Children: II. Second Clinical Trial , JAMA 187:85-89 ( (Jan 11) ) 1964.Crossref 17. Lowe, J. F.; Bamforth, J. S.; and Pracy, R.: Acute Otitis Media: One Year in General Practice , Lancet 2:1129-1132 ( (Nov 30) ) 1963.Crossref 18. McBean, J. B.: Otitic Meningitis: Review of Cases in Attempt to Evaluate Results of Treatment , Arch Otolaryng 64:253-257 ( (Oct) ) 1956.Crossref 19. Van Wormer, D. E.: Autopsy Incidence of Otitis Media in Infants , Wisconsin Med J 62:183-184 ( (April) ) 1963. 20. Heller, G.: Statistical Study of Otitis Media in Children , J Pediat 17:322-330 ( (Sept) ) 1940.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Apr 1, 1965

References