Antibiotic treatment of secretory otitis media

Abstract

There is increasing evidence for an infectious etiology of secretory otitis media (SOM). Respiratory pathogens (S. pneumoniae, H. influenzae, B. catarrhalis and group A streptococci) have been found in cases of long-standing SOM, with a frequency of 18% in the middle ear and 79% in the nasopharynx. Erythromycin has been shown to penetrate into the middle ear effusion of SOM and into adenoid tissue. The concentrations surpassed the MIC's of most respiratory pathogens, with the exception of certain strains of H. influenzae. In agreement with this, a ten day course of erythromycin in children with SOM eradicated practically all nasopharyngeal strains of S. pneumoniae and B. catarrhalis, while there was no significant decrease in the number of strains of H. influenzae. The present study consisted of 119 children with SOM lasting three months or more. One group of 47 consecutive children was treated with erythromycin (Abboticin), given orally twice a day, in a dose of 40-60 mg/kg/24 hours, for ten days. The rate of resolution in this test group was 45% (21/47 cases). Another group of 72 consecutive children with SOM of a similar duration received no antibiotics. The cure rate in this control group was 15% (11/72 cases). The difference between the two groups is statistically significant (chi 2 = 11054; df = 1; p less than 0.001). The results suggest that a ten day course of erythromycin could reduce the need for surgical treatment in children with long-standing SOM.