ORIGINAL ARTICLES
Host factors and early therapeutic response in acute otitis media Susan A. Carlin, MD, Colin D. M a r c h a n t , MD, Paul A. Shurin, MD,* C a n d i c e E. Johnson, MD, PhD, Dennis M. Super, MD, MPH, a n d James M. Rehmus, MD From the Departments of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, and Tufts University School of Medicine, Boston, Massachusetts To e v a l u a t e the relationship b e t w e e n eradication of bacterial infection and clinical improvement in children with otitis media, we reviewed the clinical outc o m e of bacterial otitis media in patients enrolled in double-blind trials of antibacterial therapy from 1979 to 1988. Cultures of middle ear exudates showed the distribution of bacterial p a t h o g e n s to be similar to that observed in other g e o g r a p h i c areas. Two hundred ninety-three patients had otitis media c a u s e d by bacterial p a t h o g e n s and underwent repeat tympanocentesis after 3 to 6 days of therapy. Bacteriologic success was demonstrated in 253 patients (86%); 40 patients (14%) had b a c t e r i o l o g i c failure. Children w h o had b a c t e r i o l o g i c failure were y o u n g e r than those with b a c t e r i o l o g i c success (median a g e 10.6 vs 18.5 months; p = 0.001); 38% of patients who had b a c t e r i o l o g i c failure were black, c o m p a r e d with 18% of patients with b a c t e r i o l o g i c success (p = 0.007). Gender, history of frequent otitis media, and presence of bilateral otitis m e d i a were not risk factors for b a c t e r i o l o g i c failure. Clinical success was d e m o n strated in 261 patients (89%); 32 patients (11%) had clinical failure. A g r e e m e n t b e t w e e n clinical and b a c t e r i o l o g i c response was 86% (95% c o n f i d e n c e interval: 81.6% to 89.6%). Ninety-three percent (236/253) of subjects whose infection was eliminated had clinical resolution, whereas 37% (15/40) of those with bacteriologic failure had persisting symptoms or signs of clinical failure. We c o n c l u d e that failure to eliminate bacteria from the middle ear is often associated with persistent signs and symptoms. Bacteriologic failure affects children
Host factors and early therapeutic response in acute otitis media Susan A. Carlin, MD, Colin D. M a r c h a n t , MD, Paul A. Shurin, MD,* C a n d i c e E. Johnson, MD, PhD, Dennis M. Super, MD, MPH, a n d James M. Rehmus, MD From the Departments of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, and Tufts University School of Medicine, Boston, Massachusetts To e v a l u a t e the relationship b e t w e e n eradication of bacterial infection and clinical improvement in children with otitis media, we reviewed the clinical outc o m e of bacterial otitis media in patients enrolled in double-blind trials of antibacterial therapy from 1979 to 1988. Cultures of middle ear exudates showed the distribution of bacterial p a t h o g e n s to be similar to that observed in other g e o g r a p h i c areas. Two hundred ninety-three patients had otitis media c a u s e d by bacterial p a t h o g e n s and underwent repeat tympanocentesis after 3 to 6 days of therapy. Bacteriologic success was demonstrated in 253 patients (86%); 40 patients (14%) had b a c t e r i o l o g i c failure. Children w h o had b a c t e r i o l o g i c failure were y o u n g e r than those with b a c t e r i o l o g i c success (median a g e 10.6 vs 18.5 months; p = 0.001); 38% of patients who had b a c t e r i o l o g i c failure were black, c o m p a r e d with 18% of patients with b a c t e r i o l o g i c success (p = 0.007). Gender, history of frequent otitis media, and presence of bilateral otitis m e d i a were not risk factors for b a c t e r i o l o g i c failure. Clinical success was d e m o n strated in 261 patients (89%); 32 patients (11%) had clinical failure. A g r e e m e n t b e t w e e n clinical and b a c t e r i o l o g i c response was 86% (95% c o n f i d e n c e interval: 81.6% to 89.6%). Ninety-three percent (236/253) of subjects whose infection was eliminated had clinical resolution, whereas 37% (15/40) of those with bacteriologic failure had persisting symptoms or signs of clinical failure. We c o n c l u d e that failure to eliminate bacteria from the middle ear is often associated with persistent signs and symptoms. Bacteriologic failure affects children
