Vol.98 No.5 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 98 No. 5 May 2005
Antibiotic Treatment Based on Clinical
Stratification of Acute Otitis Media
Yoko Sato
(Sumiyoshidai ENT Clinic)
It is known that the increase of drug-resistant bacteria is caused by overuse of antibiotics. The aim of this study is to demonstrate the effectiveness of non-antibiotic treatment depending on the clinical stratification of acute otitis media (AOM) while awaiting the results of susceptibility testing. Sixty-four patients with an age range of 0 to 12 years took part in this study. We attempted to minimize the use of antibiotics for the first three days until the results of susceptibility testing were obtained. Patients without otorrhea (92％) were classified into three categories according to the scoring system of redness and swelling of the tympanic membrane (clinical stratification): mild (36％), moderate (26％), and severe (30％) AOM. Myringotomies were performed in all severe cases and some of the moderate cases. The isolates from the nasopharynx were mainly Haemophilus influenzae (38％), Streptococcus pneumoniae (33 ％), and Branhamella catarrhalis (20％), where 28％ of H. influenzae was ampicillin-resistant and 54％ of S. pneumoniae was penicillin-resistant. Treatments were classified based on the timing of antibiotic treatment: non-antibiotic treatment throughout overall time, antibiotic treatment based on the results of susceptibility testing, antibiotic treatment on the day after the first visit, and antibiotic treatment at the first visit. Their ratios were 57％, 35％, 4％, and 4％, respectively, for mild AOM cases, 6％, 24％, 0％ and 70％ for moderate AOM cases, and 0％, 11％, 21％, and 68％ for severe AOM cases. Our results suggest that mild AOM cases can be successfully treated without using antibiotics until the results of susceptibility testing are obtained. In addition, non-antibiotic treatment for the first three days is acceptable even for some of the moderate or severe AOM cases.
Key words : acute otitis media, antibiotic, drug-resistant bacteria, myringotomy, clinical stratification