Rational therapy of acute otitis media in children based on evidence-based medicine
DOI: 10.32364/2618-8430-2022-5-3-237-243
Acute otitis media (AOM) is one of the most common diseases in children and adults, as well as the most frequent reasons for prescribing antibacterial therapy (routinely unjustified). The review presents data on the incidence of AOM among the child population in the Russian Federation, discusses the most common viral and bacterial disease pathogens. The review also introduces the term "orthotropic" viral pathogens capable of causing the AOM development with a higher probability. The review discusses the role of microbiota in the AOM development, the difficulties of diagnosis and AOM in children. It also considers the issues of AOM treatment in detail. In clinical practice, preference is given to the combination of lidocaine + phenazone due to the broad evidence base and long-term experience. The recommendation to use topical analgesic drugs as the first-line therapy in AOM during the pre-perforation period of the disease allows to implement a watchful waiting regardin g the use of antibacterial drugs, as well as to avoid adverse events of systemic NSAIDs, such as gastrointestinal disorders and nausea. The review focuses on the use of antibiotic therapy in the treatment of AOM. Rational treatment tactics of AOM allows to avoid the development of complications and the inconsistent use of antimicrobials, which will help to prevent bacterial colonization in the nasopharynx and tympanic cavity, as well as the antibiotic resistance development.
Keywords: acute otitis media, inflammatory diseases, otopathogen, lidocaine, phenazone, NSAIDs, antibiotic therapy.
For citation: Usenko D.V. Rational therapy of acute otitis media in children based on evidence-based medicine. Russian Journal of Woman and Child Health. 2022;5(3):237–243 (in Russ.). DOI: 10.32364/2618-8430-2022-5-3-237-243.
About the author:
Denis V. Usenko — Dr. Sc. (Med.), Leading Researcher of the Clinical Department of Infectious Pathology, Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; 3A, Novogireevskaya str., Moscow, 111123, Russian Federation; ORCID iD 0000-0001-5232-7337.
Contact information: Denis V. Usenko, e-mail: dusenko@rambler.ru.
Financial Disclosure: the author has no financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 09.07.2022.
Revised 02.08.2022.
Accepted 25.08.2022.
References
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12. Nair H., Nokes D.J., Gessner B.D. et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375(9725):1545–1555. DOI: 10.1016/S0140-6736(10)60206-1.
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14. Sagai S., Suetake M., Yano H. et al. Relationship between respiratory syncytial virus infection and acute otitis media in children. Auris Nasus Larynx. 2004;31(4):341–345. DOI: 10.1016/j.anl.2004.07.005.
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16. Ruuskanen O., Arola M., Putto-Laurila A. et al. Acute otitis media and respiratory virus infections. Pediatr Infect Dis J. 1989;8(2):94–99. PMID: 2495520.
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19. Pettigrew M.M., Gent J.F., Pyles R.B. et al. Viral-bacterial interactions and risk of acute otitis media complicating upper respiratory tract infection. J Clin Microbiol. 2011;49(11):3750–3755. DOI: 10.1128/JCM.01186-11.
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23. Revai K., Patel J.A., Grady J.J. et al. Association between cytokine gene polymorphisms and risk for upper respiratory tract infection and acute otitis media. Clin Infect Dis. 2009;49(2):257–261. DOI: 10.1086/599833.
24. Emonts M., Veenhoven R.H., Wiertsema S.P. et al. Genetic polymorphisms in immunoresponse genes TNFA, IL6, IL10, and TLR4 are associated with recurrent acute otitis media. Pediatrics. 2007;120(4):814–823. DOI: 10.1542/peds.2007-0524.
25. Casey J.R., Adlowitz D.G., Pichichero M.E. New patterns in the otopathogens causing acute otitis media six to eight years after introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2010;29(4):304–309. DOI: 10.1097/INF.0b013e3181c1bc48.
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28. Longtin J., Gubbay J.B., Patel S., Low D.E. High prevalence of asymptomatic bocavirus in daycare: is otitis media a confounder? J Infect Dis. 2010;202(10):1617; author reply 1618. DOI: 10.1086/656786.
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30. Williams J.V., Wang C.K., Yang C.F. et al. The role of human metapneumovirus in upper respiratory tract infections in children: a 20-year experience. J Infect Dis. 2006;193(3):387–395. DOI: 10.1086/499274.
31. Binks M.J., Cheng A.C., Smith-Vaughan H. et al. Viral-bacterial co-infection in Australian Indigenous children with acute otitis media. BMC Infect Dis. 2011;11:161. DOI: 10.1186/1471-2334-11-161.
32. Laufer A.S., Metlay J.P., Gent J.F. et al. Microbial Communities of the Upper Respiratory Tract and Otitis Media in Children. mBio. 2011;2:e00245–e00310. DOI: 10.1128/mBio.00245-10.
33. Pettigrew M.M., Laufer A.S., Gent J.F. et al. Upper Respiratory Tract Microbial Communities, Acute Otitis Media Pathogens, and Antibiotic Use in Healthy and Sick Children. Appl Environ Microbiol. 2012;78:6262–6270. DOI: 10.1128/AEM.01051-12.
34. Hilty M., Qi W., Brugger S.D. et al. Nasopharyngeal Microbiota in Infants with Acute Otitis Media. J Infect Dis. 2012;205:1048–1055. DOI: 10.1093/infdis/jis024.
35. Lappan R., Imbrogno K., Sikazwe C. et al. A microbiome case-control study of recurrent acute otitis media identified potentially protective bacterial genera. BMC Microbiol. 2018;18:13. DOI: 10.1186/s12866-018-1154-3.
36. Бойкова Н.Э., Рыбалкин С.В. Острый средний отит у детей: стандарты лечения. Педиатрия (Прил. к журн. Consilium Medicum). 2017;3:35–38. [Boykova N.E., Rybalkin S.V. Acute otitis media in children: treatment standards. Pediatrics (Suppl. Consilium Medicum). 2017;3: 35–38 (in Russ.)].
37. Национальная медицинская ассоциация оториноларингологов. Острый средний отит. Клинические рекомендации. 2021. [National Medical Association of Otorhinolaryngologists. Acute otitis media. Clinical guidelines. 2021 (in Russ.)].
38. Тулупов Д.А., Федотов Ф.А., Карпова Е.П., Грабовская В.А. Современные аспекты применения назальных сосудосуживающих и вспомогательных препаратов в педиатрической практике. Медицинский совет. 2018;2:114–117. DOI: 10.21518/2079-701X-2018-2-114-117. [Tulupov D.A., Fedotov F.A., Karpova Ye.P., Grabovskaya V.A. Current aspects of use of nasal vasoconstrictors and adjunctive agents in pediatric practice. Meditsinskiy sovet=Medical Council. 2018;2:114–117 (in Russ.)]. DOI: 10.21518/2079-701X-2018-2-114-117.
39. François M. Efficacité et tolérance d’une application locale de phénazone et de chlorhydrate de lidocaïne (Otipax) dans les otites congestives du nourrisson et de l’enfant [Efficacy and tolerance of a local application of phenazone and chlorhydrate lidocaine (Otipax) in infants and children with congestive otitis]. Ann Pediatr (Paris). 1993;40(7):481–484 (in French.). PMID: 8239401.
40. Verleye M., Heulard I., Gillardin J.M. Phenazone potentiates the local anaesthetic effect of lidocaine in mice. Pharmacol Res. 2000;41(5):539–542. DOI: 10.1006/phrs.1999.0619.
41. Карпова Е.П., Бурлакова К.Ю. Воспалительные заболевания среднего уха у детей. Медицинский совет. 2017;(9):65–69. DOI: 10.21518/2079-701X-2017-9-65-69. [Karpova Ye.P., Burlakova K.Yu. Inflammatory diseases of the middle ear in children. Meditsinskiy sovet=Medical Council. 2017;(9):65–69 (in Russ.)]. DOI: 10.21518/2079-701X-2017-9-65-69.
42. Гаращенко Т.И., Ильенко Л.И., Пайганова Н.Э. Возможности эффективной топической терапии в лечении острых средних отитов у детей. Педиатрия. Consilium Medicum. 2022;2:147–152. DOI: 10.26442/26586630.2022.2.201748. [Garashchenko T.I., Ilenko L.I., Payganova N.E. Possibilities of effective topical therapy in treatment of acute otitis media in children: A review. Pediatrics. Consilium Medicum. 2022;2:147–152 (in Russ.)]. DOI: 10.26442/26586630.2022.2.201748.
43. Lieberthal A.S., Carroll A.E., Chonmaitree T. et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964–e999. DOI: 10.1542/peds.
44. Pichichero M.E., Casey J.R., Almudevar A. Reducing the frequency of acute otitis media by individualized care. Pediatr Infect Dis J. 2013;32(5):473–478. DOI: 10.1097/INF.
2. Grijalva C.G., Nuorti J.P., Griffin M.R. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA. 2009;302(7):758–766. DOI: 10.1001/jama.2009.1163.
3. Marom T., Tan A., Wilkinson G.S. et al. Trends in otitis media-related health care use in the United States, 2001–2011. JAMA Pediatr. 2014;168(1):68–75. DOI: 10.1001/jamapediatrics.2013.3924.
4. Lieberthal A.S., Carroll A.E., Chonmaitree T. et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964–999. DOI: 10.1542/peds.2012-3488.
5. Pukander J., Karma P., Sipilä M. Occurrence and recurrence of acute otitis media among children. Acta Otolaryngol. 1982;94(5–6):479–486. DOI: 10.3109/00016488209128938.
6. Kaur R., Morris M., Pichichero M.E. Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era. Pediatrics. 2017;140(3):e20170101. Pediatrics. 2018;141(3):e20174067. DOI: 10.1542/peds.2017-4067. Erratum for: Pediatrics. 2017;140(3).
7. Chonmaitree T., Trujillo R., Jennings K. et al. Acute Otitis Media and Other Complications of Viral Respiratory Infection. Pediatrics. 2016;137(4):e20153555. DOI: 10.1542/peds.2015-3555.
8. Revai K., Dobbs L.A., Nair S. et al. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics. 2007;119(6):e1408–1412. DOI: 10.1542/peds.2006-2881.
9. Wiertsema S.P., Chidlow G.R., Kirkham L.A. et al. High detection rates of nucleic acids of a wide range of respiratory viruses in the nasopharynx and the middle ear of children with a history of recurrent acute otitis media. J Med Virol. 2011;83(11):2008–2017. DOI: 10.1002/jmv.22221.
10. Nokso-Koivisto J., Pyles R.B., Miller A.L. et al. Role of Human Bocavirus in Upper Respiratory Tract Infections and Acute Otitis Media. J Pediatric Infect Dis Soc. 2014;3(2):98–103. DOI: 10.1093/jpids/pit061.
11. Ruohola A., Pettigrew M.M., Lindholm L. et al. Bacterial and viral interactions within the nasopharynx contribute to the risk of acute otitis media. J Infect. 2013;66(3):247–254. DOI: 10.1016/j.jinf.2012.12.002.
12. Nair H., Nokes D.J., Gessner B.D. et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375(9725):1545–1555. DOI: 10.1016/S0140-6736(10)60206-1.
13. Piedra P.A. Long term healthcare costs associated with respiratory syncytial virus infection in children: the domino effect. J Infect Dis. 2020;221:1205–1257. DOI: 10.1093/infdis/jiz161.
14. Sagai S., Suetake M., Yano H. et al. Relationship between respiratory syncytial virus infection and acute otitis media in children. Auris Nasus Larynx. 2004;31(4):341–345. DOI: 10.1016/j.anl.2004.07.005.
15. Massa H.M., Cripps A.W., Lehmann D. Otitis media: viruses, bacteria, biofilms and vaccines. Med J Aust. 2009;191(S9):S44–S49. DOI: 10.5694/j.1326-5377.2009.tb02926.x.
16. Ruuskanen O., Arola M., Putto-Laurila A. et al. Acute otitis media and respiratory virus infections. Pediatr Infect Dis J. 1989;8(2):94–99. PMID: 2495520.
17. Nokso-Koivisto J., Marom T., Chonmaitree T. Importance of viruses in acute otitis media. Curr Opin Pediatr. 2015;27(1):110–115. DOI: 10.1097/MOP.0000000000000184.
18. Heikkinen T., Thint M., Chonmaitree T. Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med. 1999;340(4):260–264. DOI: 10.1056/NEJM199901283400402.
19. Pettigrew M.M., Gent J.F., Pyles R.B. et al. Viral-bacterial interactions and risk of acute otitis media complicating upper respiratory tract infection. J Clin Microbiol. 2011;49(11):3750–3755. DOI: 10.1128/JCM.01186-11.
20. Ruohola A., Meurman O., Nikkari S. et al. Microbiology of acute otitis media in children with tympanostomy tubes: prevalences of bacteria and viruses. Clin Infect Dis. 2006;43(11):1417–1422. DOI: 10.1086/509332.
21. Морозова С.В., Карапетян Л.С., Магомедова А.М. Острый вирусный средний отит: этиология, диагностика, лечение. Медицинский совет. 2020;16:95–100. DOI: 10.21518/2079-701X-2020-16-95-100. [Morozova S.V., Karapetyan L.S., Magomedova A.M. Acute viral otitis media: etiology, diagnosis, treatment. Meditsinskiy sovet=Medical Council. 2020;16:95–100 (in Russ.)]. DOI: 10.21518/2079-701X-2020-16-95-100.
22. Patel J.A., Nair S., Revai K. et al. Association of proinflammatory cytokine gene polymorphisms with susceptibility to otitis media. Pediatrics. 2006;118(6):2273–2279. DOI: 10.1542/peds.2006-0764.
23. Revai K., Patel J.A., Grady J.J. et al. Association between cytokine gene polymorphisms and risk for upper respiratory tract infection and acute otitis media. Clin Infect Dis. 2009;49(2):257–261. DOI: 10.1086/599833.
24. Emonts M., Veenhoven R.H., Wiertsema S.P. et al. Genetic polymorphisms in immunoresponse genes TNFA, IL6, IL10, and TLR4 are associated with recurrent acute otitis media. Pediatrics. 2007;120(4):814–823. DOI: 10.1542/peds.2007-0524.
25. Casey J.R., Adlowitz D.G., Pichichero M.E. New patterns in the otopathogens causing acute otitis media six to eight years after introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2010;29(4):304–309. DOI: 10.1097/INF.0b013e3181c1bc48.
26. Martin E.T., Fairchok M.P, Kuypers J. et al. Frequent and prolonged shedding of bocavirus in young children attending daycare. J Infect Dis. 2010;201(11):1625–1632. DOI: 10.1086/652405.
27. Von Linstow M.L., Hogh M., Hogh B. Clinical and epidemiologic characteristics of human bocavirus in Danish infants: results from a prospective birth cohort study. Pediatr Infect Dis J. 2008;27(10):897–902. DOI: 10.1097/INF.0b013e3181757b16.
28. Longtin J., Gubbay J.B., Patel S., Low D.E. High prevalence of asymptomatic bocavirus in daycare: is otitis media a confounder? J Infect Dis. 2010;202(10):1617; author reply 1618. DOI: 10.1086/656786.
29. Suzuki A., Watanabe O., Okamoto M. et al. Detection of human metapneumovirus from children with acute otitis media. Pediatr Infect Dis J. 2005;24(7):655–657. DOI: 10.1097/01.inf.0000168755.01196.49.
30. Williams J.V., Wang C.K., Yang C.F. et al. The role of human metapneumovirus in upper respiratory tract infections in children: a 20-year experience. J Infect Dis. 2006;193(3):387–395. DOI: 10.1086/499274.
31. Binks M.J., Cheng A.C., Smith-Vaughan H. et al. Viral-bacterial co-infection in Australian Indigenous children with acute otitis media. BMC Infect Dis. 2011;11:161. DOI: 10.1186/1471-2334-11-161.
32. Laufer A.S., Metlay J.P., Gent J.F. et al. Microbial Communities of the Upper Respiratory Tract and Otitis Media in Children. mBio. 2011;2:e00245–e00310. DOI: 10.1128/mBio.00245-10.
33. Pettigrew M.M., Laufer A.S., Gent J.F. et al. Upper Respiratory Tract Microbial Communities, Acute Otitis Media Pathogens, and Antibiotic Use in Healthy and Sick Children. Appl Environ Microbiol. 2012;78:6262–6270. DOI: 10.1128/AEM.01051-12.
34. Hilty M., Qi W., Brugger S.D. et al. Nasopharyngeal Microbiota in Infants with Acute Otitis Media. J Infect Dis. 2012;205:1048–1055. DOI: 10.1093/infdis/jis024.
35. Lappan R., Imbrogno K., Sikazwe C. et al. A microbiome case-control study of recurrent acute otitis media identified potentially protective bacterial genera. BMC Microbiol. 2018;18:13. DOI: 10.1186/s12866-018-1154-3.
36. Бойкова Н.Э., Рыбалкин С.В. Острый средний отит у детей: стандарты лечения. Педиатрия (Прил. к журн. Consilium Medicum). 2017;3:35–38. [Boykova N.E., Rybalkin S.V. Acute otitis media in children: treatment standards. Pediatrics (Suppl. Consilium Medicum). 2017;3: 35–38 (in Russ.)].
37. Национальная медицинская ассоциация оториноларингологов. Острый средний отит. Клинические рекомендации. 2021. [National Medical Association of Otorhinolaryngologists. Acute otitis media. Clinical guidelines. 2021 (in Russ.)].
38. Тулупов Д.А., Федотов Ф.А., Карпова Е.П., Грабовская В.А. Современные аспекты применения назальных сосудосуживающих и вспомогательных препаратов в педиатрической практике. Медицинский совет. 2018;2:114–117. DOI: 10.21518/2079-701X-2018-2-114-117. [Tulupov D.A., Fedotov F.A., Karpova Ye.P., Grabovskaya V.A. Current aspects of use of nasal vasoconstrictors and adjunctive agents in pediatric practice. Meditsinskiy sovet=Medical Council. 2018;2:114–117 (in Russ.)]. DOI: 10.21518/2079-701X-2018-2-114-117.
39. François M. Efficacité et tolérance d’une application locale de phénazone et de chlorhydrate de lidocaïne (Otipax) dans les otites congestives du nourrisson et de l’enfant [Efficacy and tolerance of a local application of phenazone and chlorhydrate lidocaine (Otipax) in infants and children with congestive otitis]. Ann Pediatr (Paris). 1993;40(7):481–484 (in French.). PMID: 8239401.
40. Verleye M., Heulard I., Gillardin J.M. Phenazone potentiates the local anaesthetic effect of lidocaine in mice. Pharmacol Res. 2000;41(5):539–542. DOI: 10.1006/phrs.1999.0619.
41. Карпова Е.П., Бурлакова К.Ю. Воспалительные заболевания среднего уха у детей. Медицинский совет. 2017;(9):65–69. DOI: 10.21518/2079-701X-2017-9-65-69. [Karpova Ye.P., Burlakova K.Yu. Inflammatory diseases of the middle ear in children. Meditsinskiy sovet=Medical Council. 2017;(9):65–69 (in Russ.)]. DOI: 10.21518/2079-701X-2017-9-65-69.
42. Гаращенко Т.И., Ильенко Л.И., Пайганова Н.Э. Возможности эффективной топической терапии в лечении острых средних отитов у детей. Педиатрия. Consilium Medicum. 2022;2:147–152. DOI: 10.26442/26586630.2022.2.201748. [Garashchenko T.I., Ilenko L.I., Payganova N.E. Possibilities of effective topical therapy in treatment of acute otitis media in children: A review. Pediatrics. Consilium Medicum. 2022;2:147–152 (in Russ.)]. DOI: 10.26442/26586630.2022.2.201748.
43. Lieberthal A.S., Carroll A.E., Chonmaitree T. et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964–e999. DOI: 10.1542/peds.
44. Pichichero M.E., Casey J.R., Almudevar A. Reducing the frequency of acute otitis media by individualized care. Pediatr Infect Dis J. 2013;32(5):473–478. DOI: 10.1097/INF.
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