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Effect of Patient Characteristics and Disease Manifestations on the Outcome of Acute Otitis Media at 2 Months
Jack Froom, MD;
Larry Culpepper, MD, MPH;
Charles Bridges-Webb, MD;
Peter Bowers, MD;
A. Stroobant, MD;
Jacqueline Lion;
Walter Rosser, MD;
Inese Grava-Gubins, MD;
Paul Grob, MD;
Yair Yodfat, MD;
A. I. M. Bartelds, MD;
Rae West, MB;
Bertino Somaini, MD;
Larry A. Green, MD
Arch Fam Med. 1993;2(8):841-846.
Abstract
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Background
Optimal therapy for acute otitis media (AOM) is controversial and there is no consensus regarding which antibiotic to use, how long to administer it, or whether antibiotics are effective at all. Knowledge of the effects of patient characteristics and disease manifestations is needed to individualize treatment and to evaluate large-scale trials.
Methods
Data originated from 2251 patients with AOM, aged newborn to 15 years, who participated in a prospective primary care study in eight countries. At the initial visit, medical history, symptoms, physical findings, and treatment data were recorded. Follow-up 2 months later identified changes in treatment and outcome.
Results
Patients younger than 13 months were less likely to have recovered than those aged 13 months to 15 years (P=.05). Using univariate analysis for infants aged 12 months or younger, male sex, prior episodes of AOM, and serous otitis media were associated with poor outcome. For older patients, poor outcome was associated with initial history of ear tubes, prophylactic antibiotic use, ear discharge, decreased hearing, serous otitis media; and past episodes of AOM; the symptom of decreased hearing; and the finding of pus exuding from the tympanic membrane. Using multivariate analysis for infants aged 12 months or younger, a history of serous otitis media (odds ratio [OR], 2.3; 95% confidence interval [CI], 0.95-5.7), past episodes of AOM (OR, 1.9; 95% CI, 0.82-4.5), and male sex (OR, 1.7; 95% CI, 1.0-3.0) made independent contributions to poor outcome. For children aged 13 months to 15 years, significant variables included pus drainage (OR, 2.2; 95% CI, 1.5-3.3), a history of ear tubes (OR, 2.3; 95% CI, 1.5-3.6), past episodes of AOM (OR, 1.8; 95% CI, 1.3-2.34), and a history of serous otitis media (OR, 1.4; 95% CI, 1.0-1.9).
Conclusions
Patient characteristics and disease manifestations are significant determinants of AOM outcome.
Author Affiliations
From the International Primary Care Network, do the Department of Family Medicine, Brown University/ Memorial Hospital of Rhode Island, Pawtucket (Drs Froom and Culpepper); the Australian Primary Care Network, Croydon (Drs Bridges-Webb and Bowers); Medecins Bigies/ Peilpraktijken, Brussels, Belgium (Dr Stroobant and Ms Lion); National Recording System of Canada, Toronto (Drs Rosser and Grava-Gubins); The United Kingdom Sentinel Practices Network, Guildford, England (Dr Grob); The Israel Sentinel Practices Network, Jerusalem (Dr Yodfat); the Netherlands Peilstations, Utrecht (Dr Bartelds); the New Zealand Primary Care Network, Auckland (Dr West); Sentinella, Bern, Switzerland (Dr Somaini); and the Ambulatory Sentinel Practice Network, Denver, Colo (Dr Green).
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