Acute-phase reactants and acute bacterial otitis media.
OBJECTIVE
To determine if the erythrocyte sedimentation rate and C-reactive protein level are elevated in uncomplicated acute bacterial otitis media.


METHODS
Investigator-blinded, antibiotic efficacy trial.


METHODS
The emergency department of an urban regional children's hospital with 24,000 annual visits.


METHODS
Thirty-one children with symptoms of acute bacterial otitis media of 7 days' duration or less.


METHODS
Volunteer sample.


METHODS
Tympanocentesis, oral antibiotics for 10 days, and three follow-up visits in the next 30 days.


RESULTS
The erythrocyte sedimentation rate and C-reactive protein level were obtained at time of entry into the antibiotic study. Seventeen patients (55%; 95% confidence interval, 37% to 72%) had either an erythrocyte sedimentation rate above 20 mm/h or a C-reactive protein level above 8 mg/L. Eleven patients (35%) had a recurrent episode of acute bacterial otitis media during the follow-up period. The relative risk of recurrence of otitis media given an elevated erythrocyte sedimentation rate or C-reactive protein level was 8.24 (95% confidence interval, 1.20 to 56.74; Fisher's Exact Test; P = .007).


CONCLUSIONS
Clinicians who use elevated acute-phase reactants as possible indicators of invasive bacterial infections should be aware that an elevated erythrocyte sedimentation rate or C-reactive protein level is also consistent with acute bacterial otitis media. An elevated erythrocyte sedimentation rate or C-reactive protein level also appears to be associated with an increased risk of recurrence of acute bacterial otitis media. If these findings can be confirmed in a larger study, the erythrocyte sedimentation rate or C-reactive protein level could be used to assess the risk of recurrent otitis media.
Del Beccaro
M A
MA
Emergency Services, Children's Hospital and Medical Center, Seattle, WA 98105.
Mendelman
P M
PM
Inglis
A F
AF
Richardson
M A
MA
Duncan
N O
NO
Shugerman
R P
RP
D000208:Acute Disease; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000097:blood* / Q000188:drug therapy; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D010033:Otitis Media / Q000097:blood* / Q000188:drug therapy / Q000382:microbiology; D012008:Recurrence
D000890:Anti-Infective Agents; D002097:C-Reactive Protein