1. Effectiveness of trimethoprim/sulfamethoxazole for children with chronic active otitis media: a randomized, placebo-controlled trial
- Author
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van der Veen, Erwin L., Rovers, Maroeska M., Albers, Frans W.J., Sanders, Elisabeth A.M., and Schilder, Anne G.M.
- Subjects
Otitis media -- Diagnosis ,Otitis media -- Health aspects ,Otitis media -- Care and treatment ,Pediatrics -- Health aspects ,Pediatrics -- Care and treatment ,Co-trimoxazole -- Complications and side effects ,Co-trimoxazole -- Diagnosis ,Co-trimoxazole -- Care and treatment - Abstract
OBJECTIVE. The goal was to determine the clinical effectiveness of prolonged outpatient treatment with trimethoprim/sulfamethoxazole for children with chronic active otitis media. METHODS. We performed a randomized, placebo-controlled trial with 101 children (1-12 years of age) with chronic active otitis media (defined as otorrhea for [greater than or equal to] 12 weeks). In addition to a short course of steroid and antibiotic eardrops, children were assigned randomly to receive 6 to 12 weeks of orally administered trimethoprim/sulfamethoxazole (18 mg/kg, 2 times per day) or placebo and were monitored for 1 year. RESULTS. At 6 weeks, 28% of children in the trimethoprim/sulfamethoxazole group and 53% of children in the placebo group had otomicroscopic signs of otorrhea. At 12 weeks, these values were 32% and 47%, respectively. At 1 year, the numbers of children with otorrhea were similar in the 2 groups (25% and 20%, respectively). One child in the trimethoprim/sulfamethoxazole group developed a skin rash. Vomiting or diarrhea was reported for 9% of the trimethoprim/sulfamethoxazole group and 2% of the placebo group. Pure-tone hearing levels and health-related quality of life improved during the study but did not differ between the trimethoprim/sulfamethoxazole group and the placebo group. Pseudomonas aeruginosa was the most frequently isolated bacteria in the otorrhea samples from both groups. CONCLUSIONS. A 6- to 12-week course of high-dose, orally administered trimethoprim/ sulfamethoxazole therapy is beneficial for children with chronic active otitis media. The treatment effect is most pronounced with the shorter course and disappears if administration of the medication is discontinued. www.pediatrics.org/cgi/doi/10.1542/peds.2006-2787 doi:10.1542/peds.2006-2787 Key Words chronic suppurative otitis media, children, drug therapy, trimethoprim/sulfamethoxazole combination Abbreviations COM--chronic active otitis media NNT--number needed to treat RD--rate difference CI--confidence interval, CHRONIC ACTIVE (MUCOSAL) otitis media (COM) is a common infectious disease, affecting children in both developing and industrialized countries. (1-3) It causes considerable morbidity and is a major global cause [...]
- Published
- 2007