EARLY ERADICATION OF PATHOGENS FROM MIDDLE-EAR FLUID DURING ANTIBIOTIC-TREATMENT OF ACUTE OTITIS-MEDIA IS ASSOCIATED WITH IMPROVED CLINICALOUTCOME

Objective. To determine the relation between early bacteriologic eradi cation and clinical outcome of acute otitis media (AOM) in infants and young children treated with various antibiotics. Study design. The st udy group consisted of patients ages 3 to 24 months seen at the Pediat ric Emergency Room with: (1) symptoms and physical findings consistent with AOM of less than or equal to 7 days duration; (2) no spontaneous perforation or tympanostomy tubes; (3) positive initial middle ear fl uid culture; and (4) a follow-up to at least Day 10 +/- 2 of the study with a second culture performed 72 to 96 h after initiation of antibi otic treatment. Any patient with a positive middle ear fluid culture 7 2 to 96 h after initiation of antibiotic treatment was considered to h ave bacteriologic failure. Otologic evaluation was done by an otolaryn gologist unaware of the culture results and of the study drug allocati on. A clinical score based on body temperature, report of irritability and ear tugging observed by the parents and the appearance and rednes s of the ear drum as observed by the otolaryngologist was also used fo r clinical evaluation. Results, The study group consisted of 123 patie nts, of whom 57 (46%) had positive middle ear fluid 72 to 96 h after i nitiation of antibiotic treatment. Clinical failure was observed ill 2 1 of 57 (37%) patients in whom bacteriologic eradication did not occur us. only 2 of 66 (3%) patients with bacteriologic eradication after 3 to 4 days of treatment (P < 0.001). Clinical score for both moderate and severe disease decreased significantly faster in those with bacter iologic eradication than in those in whom middle ear fluid was still c ulture-positive 72 to 96 h after initiation of treatment. Conclusion, Clinical failures in our population were associated with inability to eradicate the causative organisms of AOM from the middle ear fluid wit hin 3 to 4 days after initiation of antibiotic therapy. Most patients (including those without bacteriologic eradication) improved after 3 t o 4 days of treatment, but patients with sterile middle ear fluid felt better after 3 to 4 days of treatment than patients in whom middle ea r fluid was still culture-positive.