Clinical/otologic score before and during treatment of acute otitis media.
OBJECTIVE
To determine clinical characteristics of AOM at presentation and during therapy according to specific etiologies.


METHODS
1003 patients studied during 1996-2001 in antibiotic efficacy studies underwent tympanocentesis and middle ear fluid culture at enrollment and on Day 4-6 (in initially culture-positive patients only). We used a clinical/otologic (CO) score for evaluating severity of fever, irritability and tympanic membrane redness and bulging (0-3 each parameter, maximal score=12).


RESULTS
Seven hundred sixty-three patients had positive cultures with 392 (39%) Haemophilus influenzae, 198 (20%) Streptococcus pneumoniae and 173 (17%) mixed H. influenzae and S. pneumoniae infection. Mean CO score was higher in culture-positive versus culture-negative patients (8.21+/-2.17 vs. 7.73+/-2.32, p=0.003) regardless of isolated organism. A marked improvement in CO score was observed on Day 4-6 in all patients: 1.83+/-2.18 in children initially culture-positive and 0.9+/-1.67 in those initially culture-negative (p<0.001). The improvement was greater in patients with eradication versus those with bacteriological failure (CO score 1.52+/-1.82 vs. 2.77+/-2.85, p<0.001).


CONCLUSIONS
CO score before treatment, after bacterial eradication or in bacteriologic failures are similar in bacterial AOM and are not predictive of the etiology of the disease.
Satran
R
R
Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Leibovitz
E
E
Raiz
S
S
Piglansky
L
L
Press
J
J
Leiberman
A
A
Dagan
R
R
D000208:Acute Disease; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D006192:Haemophilus Infections / Q000175:diagnosis* / Q000188:drug therapy; D006193:Haemophilus influenzae / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D010033:Otitis Media / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents