title: Spontaneously draining acute otitis media in children: an observational study of clinical findings, microbiology and clinical course.
abstract: OBJECTIVE
  To study the outcome of acute otitis media (AOM) with otorrhoea in children managed initially without antibiotics, in relation to bacterial and clinical findings, and to identify those who may benefit from antibiotics.
  
  
  METHODS
  Otherwise healthy, not otitis prone children aged 2-16 y, presenting with AOM with spontaneous otorrhoea, were recruited from primary care and followed at selected ear, nose and throat (ENT) clinics. Specimens for bacterial investigations were obtained; symptoms were registered on a daily basis. The main outcomes measured were the frequency of children treated with antibiotics due to persisting AOM within 9 days in relation to clinical and bacteriological findings, and new AOM within 3 months.
  
  
  RESULTS
  Twelve of 71 children who completed the trial received antibiotics during the first 9 days due to lack of improvement. One received antibiotics after 16 days due to relapsing AOM and 6 received antibiotics after 30 days due to new AOM. At 2-4 days following inclusion, over 70% of children showed normalized eardrum status and markedly reduced secretion. Alloiococcus otitidis was found in 23 samples, Streptococcus pneumoniae in 12, Streptococcus pyogenes in 6, and Fusobacterium nucleatum in 5. Mycoplasma pneumoniae, Chlamydia pneumoniae, and Fusobacterium necrophorum were not detected. Antibiotics were prescribed more extensively to children with a pulsating eardrum and abundant purulent secretion. All children with S. pyogenes received antibiotics, whereas children with only A. otitidis did not.
  
  
  CONCLUSIONS
  The results suggest that antibiotics are indicated in AOM with otorrhoea and the presence of abundant purulent secretion, a pulsating eardrum, or the presence of S. pyogenes. The presence of only A. otitidis was not associated with a more prolonged course or the need for antibiotics.
authors: Primary Health Centre in Lindsdal, Kalmar, Sweden. thomasn@ltkalmar.se
authors: Thomas
authors: T
authors: Neumark
authors: Maria
authors: M
authors: Ekblom
authors: Lars
authors: L
authors: Brudin
authors: Anita
authors: A
authors: Groth
authors: Ingvar
authors: I
authors: Eliasson
authors: Sigvard
authors: S
authors: Mölstad
authors: Ann-Cathrine
authors: AC
authors: Petersson
authors: Annika
authors: A
authors: Törngren
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010033:Otitis Media / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents