Spontaneously draining acute otitis media in children: An observational study of clinical findings, microbiology and clinical course

Abstract

Objectives: To study the outcome of acute otitis media (AOM) with otorrhoea in children managed initially without antibiotics, in relation to bacterial and clinical findings, and to identify those who may benefit from antibiotics. Methods: Otherwise healthy, not otitis prone children aged 2–16 y, presenting with AOM with spontaneous otorrhoea, were recruited from primary care and followed at selected ear, nose and throat (ENT) clinics. Specimens for bacterial investigations were obtained; symptoms were registered on a daily basis. The main outcomes measured were the frequency of children treated with antibiotics due to persisting AOM within 9 days in relation to clinical and bacteriological findings, and new AOM within 3 months. Results: Twelve of 71 children who completed the trial received antibiotics during the first 9 days due to lack of improvement. One received antibiotics after 16 days due to relapsing AOM and 6 received antibiotics after 30 days due to new AOM. At 2–4 days following inclusion, over 70% of children showed normalized eardrum status and markedly reduced secretion. Alloiococcus otitidis was found in 23 samples, Streptococcus pneumoniae in 12, Streptococcus pyogenes in 6, and Fusobacterium nucleatum in 5. Mycoplasma pneumoniae, Chlamydia pneumoniae, and Fusobacterium necrophorum were not detected. Antibiotics were prescribed more extensively to children with a pulsating eardrum and abundant purulent secretion. All children with S. pyogenes received antibiotics, whereas children with only A. otitidis did not. Conclusions: The results suggest that antibiotics are indicated in AOM with otorrhoea and the presence of abundant purulent secretion, a pulsating eardrum, or the presence of S. pyogenes. The presence of only A. otitidis was not associated with a more prolonged course or the need for antibiotics.

Keywords::

• Acute otitis media
• perforation
• otorrhoea
• Alloiococcus otitidis
• tympanic membrane

Acknowledgements

The authors gratefully acknowledge the valuable assistance of participating ENT clinics and the other staff members at the participating primary care centres. The study was financially supported by: FORSS - Medical Research Council of Southeast Sweden, Department of Research and Development, Kalmar County Council, and Strama – The Swedish Strategic Program for the Rational Use of Antimicrobial Agents and Surveillance of Resistance.

Declaration of interest: There were no conflicts of interest.