Tympanogram Results May Guide Appropriate Use of Abx in Acute Otitis Media

HealthDay News — For young children with acute otitis media (AOM), older age and peaked tympanogram at entry are associated with reduced risk of treatment failure, according to research published in Pediatrics.

Paula A. Tähtinen, MD, PhD, from the Turku University Hospital in Finland, and colleagues conducted a secondary analysis of a randomized trial. A total of 319 children aged 6 to 35 months with AOM were randomized to receive 7 days of amoxicillin-clavulanate or placebo.

The researchers found that 31.7% of all children had treatment failure. The risk for treatment failure was reduced for older age (24 to 35 months) and with peaked tympanogram at entry (hazard ratios, 0.53 and 0.43, respectively). 

Children with severe bulging of the tympanic membrane had the highest rate difference for treatment failure between antimicrobial treatment and placebo groups (11.1% vs 64.1%; rate difference, −53.0%), resulting in a number needed to treat of 1.9.

“Children with severe bulging of the tympanic membrane seem to benefit most from antimicrobial treatment of AOM,” the authors write. “On the other hand, children with peaked tympanogram (A and C curves) may be optimal candidates for initial observation.”

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Tähtinen PA, Laine MK, Ruohola A. Prognostic factors for treatment failure in acute otitis media. Pediatrics. 2017 Sep;140(3). pii: e20170072.