Middle ear fluid histamine and leukotriene B4 in acute otitis media: effect of antihistamine or corticosteroid treatment.
OBJECTIVE
Two potent mediators of acute inflammation, histamine and leukotriene B4 (LTB4), have been shown to play important roles in the pathogenesis and clinical course of acute otitis media (AOM) in children. The purpose of this study was to evaluate the ability of adjuvant drugs, antihistamine and corticosteroid, in reduction of the levels of histamine and LTB4 in the middle ear and their ability to improve outcomes of AOM.


METHODS
Eighty children with AOM (aged 3 months to 6 years) were enrolled in a prospective, randomized, double-blind, placebo controlled study. All children received one dose of intramuscular ceftriaxone and were randomly assigned to receive either chlorpheniramine maleate (0.35 mg/kg per day) and/or prednisolone (2 mg/kg per day) or placebos three times a day for 5 days. Tympanocentesis was performed at enrollment and after 5 days of adjuvant drug treatment. MEFs were collected for bacterial and viral studies and histamine and LTB4 levels. The subjects were followed for the duration of middle ear effusion or up to 3 months.


RESULTS
Histamine or LTB4 levels in the MEF after 5 days of treatment were not significantly reduced by adjuvant drug treatment. However, subjects receiving corticosteroid had a lower rate of treatment failure during the first 2 weeks and shorter duration of middle ear effusion.


CONCLUSIONS
Five day of antihistamine or corticosteroid treatment does not reduce the levels of histamine or leukotriene B4 in the MEF of children with AOM. Positive clinical outcomes of AOM cases associated with corticosteroid treatment needs to be confirmed in a larger clinical trial of children with intact tympanic membranes, who do not receive tympanocentesis.
McCormick
David P
DP
Department of Pediatrics, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0371, USA.
Saeed
Kokab
K
Uchida
Tatsuo
T
Baldwin
Constance D
CD
Deskin
Ronald
R
Lett-Brown
Michael A
MA
Heikkinen
Terho
T
Chonmaitree
Tasnee
T
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002744:Chlorpheniramine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004432:Ear, Middle / Q000737:chemistry* / Q000187:drug effects / Q000378:metabolism*; D005260:Female; D006632:Histamine / Q000032:analysis*; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007975:Leukotriene B4 / Q000032:analysis*; D008297:Male; D010034:Otitis Media with Effusion / Q000188:drug therapy* / Q000378:metabolism*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D006634:Histamine H1 Antagonists; D007975:Leukotriene B4; D002744:Chlorpheniramine; D002443:Ceftriaxone; D006632:Histamine; D011239:Prednisolone