Has PCV7 immunization changed infection patterns in acute otitis media?

January 01, 0001

Has PCV7 immunization changed infection patterns in acute otitis media?

Acute otitis media (AOM) is a common cause of acute visits in children and is the most common reason for an antibiotic prescription for children in the US. These US researchers performed a systematic review on AOM treatment and the association of heptavalent pneumococcal conjugate vaccine (PCV7) use, searching PubMed, Cochrane Databases, and Web of Science. Included studies were observational studies and randomized controlled trials comparing AOM microbiology with and without PCV7, and randomized controlled trials assessing antibiotic treatment.

The researchers found: "In the few available studies, prevalence of Streptococcus pneumoniae decreased (eg, 33%-48% vs 23%-31% of AOM isolates), while that of Haemophilus influenzae increased (41%-43% vs 56%-57%) pre- vs post-PCV7. Short-term clinical success was higher for immediate use of ampicillin or amoxicillin vs placebo (73% vs 60%, pooled rate difference, 12%, number needed to treat, 9), while increasing the rate of rash or diarrhea by 3% to 5%. Two of 4 studies showed greater clinical success for immediate vs delayed antibiotics (95% vs 80%, rate difference, 15% and 86% vs 70%, rate difference, 16%). Data are absent on long-term effects on antimicrobial resistance. Meta-analyses in general showed no significant differences in antibiotic comparative effectiveness."

The researchers concluded: "AOM microbiology has changed with use of PCV7. Antibiotics are modestly more effective than no treatment but cause adverse effects in 4% to 10% of children. Most antibiotics have comparable clinical success."

PCV7 has affected the pathogen pattern in acute otitis media, although the affect on resistance is unclear.

For the full abstract, click here.

JAMA 304(19):2161-2169, 17 November 2010 © 2010 to the American Medical Association
Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children: A Systematic Review. Tumaini R. Coker, Linda S. Chan, Sydne J. Newberry, et al.

Category: H. Ear. Keywords: acute otitis media, PCV7, Streptococcus pneumoniae, Haemophilus influenzae, treatment, systematic review with meta-analysis., journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 7 December 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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