Trends in Acute Otitis Media

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Summary and Comment

Trends in Acute Otitis Media

The incidences of otitis media, treatment failure, and relapse have declined during the past decade.

To assess changes in incidence of acute otitis media (AOM), Boston investigators retrospectively reviewed 9 years of visits for AOM in children (age range, 2 months to 12 years) in a multispecialty provider group that served 275,000 pediatric patients.

From 1996 through 2004, incidence of AOM declined significantly, from 385 to 189 visits per 1000 person-years. Use of high-dose amoxicillin ( $≥$ 70 mg/kg daily) rose significantly, from 2% of AOM visits in 1996 to 42% in 2004, whereas use of regular-dose amoxicillin and trimethoprim-sulfamethoxazole declined significantly. Both treatment failure (defined as a second AOM visit associated with a different antibiotic prescription before completion of the first prescription) and relapse rate (a second AOM visit associated with a different prescription within 30 days of the first visit) declined slightly, from 3.9% to 2.6% and from 9.2% to 8.9%, respectively. Receipt of high-dose amoxicillin did not protect against treatment failure or relapse.

Comment: The authors acknowledge that the 50% decline in the incidence of AOM during the past decade likely results from many factors, including new vaccines. Lack of association between high-dose amoxicillin and treatment failure or relapse is more provocative: Although the American Academy of Pediatrics recommends high-dose amoxicillin for children with AOM (Journal Watch Pediatrics and Adolescent Medicine Apr 26 2004), this recommendation is based primarily on in vitro data rather than actual practice.

— Howard Bauchner, MD

Published in Journal Watch General Medicine April 10, 2008