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November 26, 1997, Vol 278, No. 20 >
ARTICLE | November 26, 1997

Short-Course Antimicrobial Treatment for Acute Otitis Media: Title and subTitle BreakNot Best for Infants and Young Children FREE

Jack L. Paradise, MD
[+] Author Affiliations

Reprints: Jack L. Paradise, MD, Children's Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213-2583.

Controversies section editor: Phil B. Fontanarosa, MD, Senior Editor.


JAMA. 1997;278(20):1640-1642. doi:10.1001/jama.1997.03550200016006
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References

IN RECENT years a number of authors—this author among them—have called for restricting, in varying degree, the use of antimicrobials in treating otitis media.1-5 Two factors have prompted these recommendations: compelling evidence that selective pressure from antimicrobial use contributes importantly to the rising prevalence of infections caused by multidrug resistant Streptococcus pneumoniae,6,7 and the fact that otitis media accounts for a large proportion of all antimicrobial use. For example, in 1986, of 44.5 million office-based prescriptions for antimicrobials for children younger than 10 years, 42% were for otitis media8; while in 1990,1 or more drugs—mainly antimicrobials—were prescribed at more than 80% of the estimated 24.5 million visits to physicians' offices for otitis media.9,10 Of those visits, children younger than 2 years accounted for 33.3%; children aged 2 to 5 years, 29.2%; and children aged 6 to 14 years, 17.9%.9 In a recent prospective study, antimicrobial

REFERENCES

1 +
Cunningham AS.  Antibiotics for otitis media: restraint, not routine . Contemp Pediatr . 1994;;11( (3) ):17-30.
2 +
Murray BE.  Can antibiotic resistance be controlled? N Engl J Med . 1994;;330:1229-1230.
3 +
Lieberman JM.  Bacterial resistance in the '90s . Contemp Pediatr . 1994;;11 ( (9) ):72-99.
4 +
Bernstein JM.  Otitis media with effusion: to treat or not to treat? J Resp Dis . 1995;;16( (1) ):88-99.
5 +
Paradise JL.  Managing otitis media: a time for change . Pediatrics . 1995;;96:712-715.
6 +
Tomasz A.  Multiple-antibiotic-resistant pathogenic bacteria . N Engl J Med . 1994;;330:1247-1251.
7 +
Breiman RF, Butler JC, Tenover FC, Elliott JA, Facklam RR.  Emergence of drug-resistant pneumococcal infections in the United States . JAMA . 1994;;271:1831-1835.
8 +
Nelson WL, Kuritsky JN, Kennedy DL, Lao CS. Outpatient pediatric antibiotic use in the US. In: Program and abstracts of the 27th Interscience Conference on Antimicrobial Agents and Chemotherapy, American Society for Microbiology; October 4-7, 1987; Washington, DC.
9 +
Schappert SM. Office Visits for Otitis Media: United States, 1975-90 . Hyattsville, Md: National Center for Health Statistics; 1992;.
10 +
Nelson CR. Drug Utilization in Office Practice: National Ambulatory Medical Care Survey, 1990 . Hyattsville, Md: National Center for Health Statistics; 1993;.
11 +
Paradise JL, Rockette HE, Colborn DK, et al.  Otitis media in 2253 Pitts-burgh-area infants: prevalence and risk factors during the first two years of life . Pediatrics . 1997;;99:318-333.
12 +
Paradise JL.  On classifying otitis media as suppurative or nonsuppurative, with a suggested clinical schema . J Pediatr . 1987;;111:948-951.
13 +
Van Buchem FL, Peeters MF, Van't Hof MA.  Acute otitis media: a new treatment strategy . BMJ . 1985;;290:1033-1037.
14 +
Kaleida PH, Casselbrant ML, Rockette HE, et al.  Amoxicillin or myringotomy or both for acute otitis media . Pediatrics . 1991;;87:466-474.
15 +
Paradise JL.  Treatment guidelines for otitis media: the need for breadth and flexibility . Pediatr Infect Dis J . 1995;;14:429-435.
16 +
Ingvarsson L, Lundgren K.  Penicillin treatment of acute otitis media in children . Acta Otolaryngol Suppl (Stockh) . 1982;;94:283-287.
17 +
Harsten G, Prellner K, Heldrup J, Kalm O, Kornfalt R.  Treatment failure in acute otitis media: a clinical study of children during their first three years of life . Acta Otolaryngol Suppl (Stockh) . 1989;;108:253-258.
18 +
Carlin SA, Marchant CD, Shurin PA, Johnson CE, Super DM, Rehmus JM.  Host factors and early therapeutic response in acute otitis media . J Pediatr . 1991;;118:178-183.
19 +
Hathaway TJ, Katz HP, Dershewitz RA, Marx TJ.  Acute otitis media: who needs posttreatment follow-up? Pediatrics . 1994;;94:143-147.
20 +
Chaput de Saintonge DM, Levine DF, Temple Savage I, et al.  Trial of threeday and ten-day course of amoxycillin in otitis media . BMJ . 1982;;284:1078-1081.
21 +
Meistrup-Larsen K-I, Sørensen H, Johnsen N-J, Thomsen J, Mygind N, Sederberg-Olsen J.  Two versus seven days penicillin treatment for acute otitis media . Acta Otolaryngol Suppl (Stockh) . 1983;;96:99-104.
22 +
Bain J, Murphy E, Ross F.  Acute otitis media: clinical course among children who received a short course of high dose antibiotic . BMJ . 1985;;291:1243-1246.
23 +
Jones R, Bain J.  Three-day and seven-day treatment in acute otitis media: a double-blind antibiotic trial . J R Coll Gen Pract . 1986;;36:356-358.
24 +
Puczynski MS, Stankiewicz JA, O'Keefe JP.  Single dose amoxicillin treatment of acute otitis media . Laryngoscope . 1987;;97:16-18.
25 +
Hendrickse WA, Kusmiesz H, Shelton S, Nelson JD.  Five vs ten days of therapy for acute otitis media . Pediatr Infect Dis J . 1988;;7:14-23.
26 +
Gooch WM III, Blair E, Puopolo A, et al.  Effectiveness of five days of therapy with cefuroxime axetil suspension for treatment of acute otitis media . Pediatr Infect Dis J . 1996;;15:157-164.
27 +
Hoberman A, Paradise JL, Burch DJ, et al.  Equivalent efficacy and reduced occurrence of diarrhea from a new formulation of amoxicillin/clavulanate potassium (Augmentin) for treatment of acute otitis media in children . Pediatr Infect Dis J . 1997;;16:463-470.
28 +
Varsano I, Frydman M, Amir J, Alpert G.  Single intramuscular dose of ceftriaxone as compared to 7-day amoxicillin therapy for acute otitis media in children: a double-blind clinical trial . Chemotherapy . 1988;;34( (suppl 1) ):39-46.
29 +
Green SM, Rothrock SG.  Single-dose intramuscular ceftriaxone for acute otitis media in children . Pediatrics . 1993;;91:23-30.
30 +
Chamberlain JM, Boenning DA, Waisman Y, Ochsenschlager DW, Klein BL.  Single-dose ceftriaxone versus 10 days of cefaclor for otitis media . Clin Pediatr . 1994;;33:642-646.
31 +
Barnett ED, Teele DW, Klein JO, Cabral HJ, Kharasch SJ, the Greater Boston Otitis Media Study Group.  Comparison of ceftriaxone and trimethoprimsulfamethoxazole for acute otitis media . Pediatrics . 1997;;99:23-28.
32 +
Hoberman A, Paradise JL, Block S, Burch DJ, Jacobs MR, Balanescu MI.  Efficacy of amoxicillin/clavulanate for acute otitis media: relation to Streptococcus pneumoniae susceptibility . Pediatr Infect Dis J . 1996;;15:955-962.
33 +
Cantekin EI, Mandel EM, Bluestone CD, et al.  Lack of efficacy of a decongestant-antihistamine combination for otitis media with effusion ('secretory' otitis media) in children . N Engl J Med . 1983;;308:297-301.
34 +
Mandel EM, Rockette HE, Bluestone CD, Paradise JL, Nozza RJ.  Efficacy of amoxicillin with and without decongestant-antihistamine for otitis media with effusion in children . N Engl J Med . 1987;;316:432-437.
35 +
Casselbrant ML, Kaleida PH, Rockette HE, et al.  Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media . Pediatr Infect Dis J . 1992;;11:278-286.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Cunningham AS.  Antibiotics for otitis media: restraint, not routine . Contemp Pediatr . 1994;;11( (3) ):17-30.
2 +
Murray BE.  Can antibiotic resistance be controlled? N Engl J Med . 1994;;330:1229-1230.
3 +
Lieberman JM.  Bacterial resistance in the '90s . Contemp Pediatr . 1994;;11 ( (9) ):72-99.
4 +
Bernstein JM.  Otitis media with effusion: to treat or not to treat? J Resp Dis . 1995;;16( (1) ):88-99.
5 +
Paradise JL.  Managing otitis media: a time for change . Pediatrics . 1995;;96:712-715.
6 +
Tomasz A.  Multiple-antibiotic-resistant pathogenic bacteria . N Engl J Med . 1994;;330:1247-1251.
7 +
Breiman RF, Butler JC, Tenover FC, Elliott JA, Facklam RR.  Emergence of drug-resistant pneumococcal infections in the United States . JAMA . 1994;;271:1831-1835.
8 +
Nelson WL, Kuritsky JN, Kennedy DL, Lao CS. Outpatient pediatric antibiotic use in the US. In: Program and abstracts of the 27th Interscience Conference on Antimicrobial Agents and Chemotherapy, American Society for Microbiology; October 4-7, 1987; Washington, DC.
9 +
Schappert SM. Office Visits for Otitis Media: United States, 1975-90 . Hyattsville, Md: National Center for Health Statistics; 1992;.
10 +
Nelson CR. Drug Utilization in Office Practice: National Ambulatory Medical Care Survey, 1990 . Hyattsville, Md: National Center for Health Statistics; 1993;.
11 +
Paradise JL, Rockette HE, Colborn DK, et al.  Otitis media in 2253 Pitts-burgh-area infants: prevalence and risk factors during the first two years of life . Pediatrics . 1997;;99:318-333.
12 +
Paradise JL.  On classifying otitis media as suppurative or nonsuppurative, with a suggested clinical schema . J Pediatr . 1987;;111:948-951.
13 +
Van Buchem FL, Peeters MF, Van't Hof MA.  Acute otitis media: a new treatment strategy . BMJ . 1985;;290:1033-1037.
14 +
Kaleida PH, Casselbrant ML, Rockette HE, et al.  Amoxicillin or myringotomy or both for acute otitis media . Pediatrics . 1991;;87:466-474.
15 +
Paradise JL.  Treatment guidelines for otitis media: the need for breadth and flexibility . Pediatr Infect Dis J . 1995;;14:429-435.
16 +
Ingvarsson L, Lundgren K.  Penicillin treatment of acute otitis media in children . Acta Otolaryngol Suppl (Stockh) . 1982;;94:283-287.
17 +
Harsten G, Prellner K, Heldrup J, Kalm O, Kornfalt R.  Treatment failure in acute otitis media: a clinical study of children during their first three years of life . Acta Otolaryngol Suppl (Stockh) . 1989;;108:253-258.
18 +
Carlin SA, Marchant CD, Shurin PA, Johnson CE, Super DM, Rehmus JM.  Host factors and early therapeutic response in acute otitis media . J Pediatr . 1991;;118:178-183.
19 +
Hathaway TJ, Katz HP, Dershewitz RA, Marx TJ.  Acute otitis media: who needs posttreatment follow-up? Pediatrics . 1994;;94:143-147.
20 +
Chaput de Saintonge DM, Levine DF, Temple Savage I, et al.  Trial of threeday and ten-day course of amoxycillin in otitis media . BMJ . 1982;;284:1078-1081.
21 +
Meistrup-Larsen K-I, Sørensen H, Johnsen N-J, Thomsen J, Mygind N, Sederberg-Olsen J.  Two versus seven days penicillin treatment for acute otitis media . Acta Otolaryngol Suppl (Stockh) . 1983;;96:99-104.
22 +
Bain J, Murphy E, Ross F.  Acute otitis media: clinical course among children who received a short course of high dose antibiotic . BMJ . 1985;;291:1243-1246.
23 +
Jones R, Bain J.  Three-day and seven-day treatment in acute otitis media: a double-blind antibiotic trial . J R Coll Gen Pract . 1986;;36:356-358.
24 +
Puczynski MS, Stankiewicz JA, O'Keefe JP.  Single dose amoxicillin treatment of acute otitis media . Laryngoscope . 1987;;97:16-18.
25 +
Hendrickse WA, Kusmiesz H, Shelton S, Nelson JD.  Five vs ten days of therapy for acute otitis media . Pediatr Infect Dis J . 1988;;7:14-23.
26 +
Gooch WM III, Blair E, Puopolo A, et al.  Effectiveness of five days of therapy with cefuroxime axetil suspension for treatment of acute otitis media . Pediatr Infect Dis J . 1996;;15:157-164.
27 +
Hoberman A, Paradise JL, Burch DJ, et al.  Equivalent efficacy and reduced occurrence of diarrhea from a new formulation of amoxicillin/clavulanate potassium (Augmentin) for treatment of acute otitis media in children . Pediatr Infect Dis J . 1997;;16:463-470.
28 +
Varsano I, Frydman M, Amir J, Alpert G.  Single intramuscular dose of ceftriaxone as compared to 7-day amoxicillin therapy for acute otitis media in children: a double-blind clinical trial . Chemotherapy . 1988;;34( (suppl 1) ):39-46.
29 +
Green SM, Rothrock SG.  Single-dose intramuscular ceftriaxone for acute otitis media in children . Pediatrics . 1993;;91:23-30.
30 +
Chamberlain JM, Boenning DA, Waisman Y, Ochsenschlager DW, Klein BL.  Single-dose ceftriaxone versus 10 days of cefaclor for otitis media . Clin Pediatr . 1994;;33:642-646.
31 +
Barnett ED, Teele DW, Klein JO, Cabral HJ, Kharasch SJ, the Greater Boston Otitis Media Study Group.  Comparison of ceftriaxone and trimethoprimsulfamethoxazole for acute otitis media . Pediatrics . 1997;;99:23-28.
32 +
Hoberman A, Paradise JL, Block S, Burch DJ, Jacobs MR, Balanescu MI.  Efficacy of amoxicillin/clavulanate for acute otitis media: relation to Streptococcus pneumoniae susceptibility . Pediatr Infect Dis J . 1996;;15:955-962.
33 +
Cantekin EI, Mandel EM, Bluestone CD, et al.  Lack of efficacy of a decongestant-antihistamine combination for otitis media with effusion ('secretory' otitis media) in children . N Engl J Med . 1983;;308:297-301.
34 +
Mandel EM, Rockette HE, Bluestone CD, Paradise JL, Nozza RJ.  Efficacy of amoxicillin with and without decongestant-antihistamine for otitis media with effusion in children . N Engl J Med . 1987;;316:432-437.
35 +
Casselbrant ML, Kaleida PH, Rockette HE, et al.  Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media . Pediatr Infect Dis J . 1992;;11:278-286.

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