Antibiotics and Otitis Media
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Reading Head: Antibiotics and Otitis Media
Antibiotics and Otitis Media
Student Name
University
Executive Summary
This report aims at addressing the disease Otitis Media and its treatment with antibiotics. It is a review about the research conducted on Otitis Media so far along with its implications, and treatment. Along with these, this report shall be addressing the following questions:
Despite proper treatment, Why the chance of reoccurrence of otitis media is higher.?.
The treatment for the disease is primarily focused with bacterial pathogens?
In cases of viral coinfection, antibiotics prescribed enhance the inflammation rate, why the treatment is still primarily concerned toward antibacterial agents?
This report highlights the current trends and clinical challenges along with addressing whether the grant for further funding of research in this field be permitted.
Contents
Executive Summary………………………………………………………………………………………………….….2
Introduction…………………………………………………………………………………………………………….….4
Predisposing Factors associated with Otitis Media………………………………………………………4
Pathogenesis……………………………………………………………………………………………………………….5
Treatment…………………………………………………………………………………………………………………………………5
Complications of Otitis Media……………………………………………………………………………………………………6
Management…………………………………………………………………………………………………………………………….7
Conclusion……………………………………………………………………………………………………………………………….8
Introduction
Otitis Media is an inflammatory ear disease which can be infectious or non-infectious in origin. It is commonly observed in children. It primarily affects the middle ear, causing dysfunction of Eustachian tube leading to pus formation and discharge from the ear. This discharge occurs due to perforation in the tymphanic membrane. Frequently, Streptococcus pneumoniae has been found associated with the infection (Haidar, 2017). Haemophilus influenza and Morazella Catarrhalis follow the sequence (Hernández-Vaquero GE et al., 2017). It has been observed that infants and young children between 6 months to 36 months have been the mostly affected (Ilechukwu et al., 2014). Almost in all cases bacteria have been found the profound culprit. The treatment with antibiotics shows beneficiary effect. However, its reoccurrence has been frequent and resistant to antibiotics by the bacteria is not uncommon.
About 80% of the children have experienced at least one episode of Otitis Media by the age of 3 years and almost 50% of the children have the experienced reoccurrence. The reasons why children face such problems are primarily associated poorly developed immune system and narrowly developed physical features of ear and nose.
Predisposing Factors associated with Otitis Media
Smoking has been found as one of the major reasons for children to suffer with Otitis Media. Collect et al in the year 1995 observed that children of mothers who smoke 20 or more cigrattes a day suffered from the diseases more often than non – smokers (Collect et al, 1995). Children suffering from upper respiratory tract infection such as rhinitis and nasopharynigitis were more prone to be attacked as these diseases set a stage for the pathogenic bacteria to invade the middle ear via the Eustachian tube. According to Breman et al, children who were breastfed for short duration were more affected and they suffered from acute otitis pathogens. This is probably because of the deficiency of immunoglobulin G which is responsible for providing innate immunity. IgG is transferred to the child through breast milk. It prevents the colonization of pathogens and also inhibits their aspiration into the middle ear (Breman et al, 2001). A study conducted by Paradise et al in the year 2004 suggested that the presence of viral infection considerably increased the chances of bacterial adherence in the nasopharyngeal area (Paradise et al, 2004).
Children suffering from measles, pertussis, tuberculosis or immunosuppression are more prone to be affected by otitis media (Ibeziako NS, 1999). The infections of the respiratory tract are associated with chemotaxis or phagocytosis. It was found by Obiakor, M.N, in the year 2002 that children having congenital or acquired immunodeficiency are associated with phagocyte function (Obiakor, 2002).
There are many other factors associated with the occurrence of otitis media. However, much of them are not evidently proved. Most of the time the cause of the disease is predefined and further treatments are designed on the basis of a pre-assumed fact. However, the possibility of some unexpected results cannot be ruled out. Further, in this context, we require more and more of research work to be done to understand further about the pathogenesis of the disease.
Pathogenesis
Primarily, according to the known pathogenesis, otitis is caused by viruses and bacteria. The most commonly affecting viruses include rhinovirus, coronavirus, adenovirus, and parainfluenza. Predominantly, the bacteria that cause otitis media are Streptococcus pneumoniae, followed by Moraxella catarrhalis, and non-typeable Haemophilus influenza (Shaikh & Hoberman, 2010). The bacteria’s primary site of attack is the Eustachian tube. The bacteria cause abnormal functioning of this tube. The tympanic cavity relates to the nasopharynx by the Eustachian tube. It is the primary layer of defense mechanism of the middle ear. It performs the function of maintaining equilibration of atmospheric pressure with the middle ear pressure. It provides protection against the reflux of nasopharyngeal secretions to the middle ear. The drains in the middle ear are secreted to the nasopharynx by Eustachian tube (Paradise et al, 2004). When physical features are compared, children have a more horizontally aligned Eustachian tube when compared to adults. This paves way for much easier spread of infection from the nasopharynx to the middle ear (Oni AA et al, 2001).
Although the pathogenesis has found to be associated with both bacteria and viruses, the treatments are concerned majorly with antibacterial agents. But there are reports suggesting that viruses also play an equal role as a casual organism (Chonmaitree, 2006). Antibiotic treatment may not be an efficient option in case of viral coinfection. In such cases the it may increase the inflammation rate and affect the efficacy of the antibiotic therapy. There are diseases that involve the concept of simultaneous bacterial and viral infection such as sinusitis and pneumonia. However, the same concept cannot be applied in case of otitis media. Further studies are required to explore the possibilities of treating bacterial-viral coinfection and subsequently understand the possible ways of treatment in such cases. Exploring such scenarios require large amount of data collection and rigorous effort towards achieving a better treatment procedure, which in turn requires more grants to facilitate the research. Continuous research with the supply of enough grants on the specific topic shall enhance the chances of getting a better treatment procedure.
Treatment
Treatment for this disease is suggested based on the patient’s conditions. Antibiotic therapy is the most common in which the antibiotic amoxicillin or a combination of amoxicillin-clavulanic acid is prescribed to the children. Penicillin is as well used however with patients allergic to penicillin, erythromycin or clindamycin along with sulfonamide is adviced (Fairbanks et al, 2007). When antibiotics are administered there are possibilities of adverse effects of treatment o the child. Antibiotic resistance is an important issue when considering the treatment of acute otitis media. Antibiotics prove to be beneficial when treating otitis media. However, while addressing the possibility of treatment towards reoccurrence of the disease, the antibiotics show very low proficiency. In order to avoid this situation, it is necessary to understand the basic cause of the disease and to design a therapy based on the microbiological identification, and the antibiotic resistance. Hernández-Vaquero GE et al., demonstrated that Ceftriaxone and Ofloxacin has been found to be effective in case of antibiotic resistance (Hernández-Vaquero GE et al., 2017). Other effective combination of antibiotics include erythromycin combined with a trimethoprim-sulfamethoxazole, cefaclor, cefuroxime axetil or cefixime.
As stated above, the treatment procedures available are majorly targeting bacteria based infections. On the other side of the court, a proper treatment toward viral infection is not available. This may be point of concern, and in this context, it is necessary to look forward for a better research outcome to ensure a better treatment towards the disease.
Complications of Otitis Media
Suppurative otitis media develops complications if infection spreads to the nearby structures from the middle ear cleft. This nearby structure which is a mucosa-lined space is usually separated by bone. The associated complications can be Intratemporal (within the temporal bone) or Intracranial. Intratemporal complications include Hearing impairment, Acute mastoiditis, and Petrositis. Facial paralysis can be a complication associated with both acute and chronic otitis media. Other complications include skin rash, diarrhea, vomiting.
Diseases develop complications when the underlying problem is unaddressed. Most of the diseases which reoccur are because most of the issues related to them are unexplored. There is very little knowledge and understanding about the cause of the disease. The treatment is targeted more toward one of the pathogen. The available antibiotic treatment shows optimal result in case of viral infection as well. However, the efficacy is not considerable and there have possibly situations where the antibiotic therapy has enhanced the inflammation therapy in case of the viral counter partner. The complications associated with the administration of antibiotics is quite severe. According to a data obtained from a report using CASP, the administration of antibiotics resulted in unwanted consequences such as skin rash, vomiting and diarrhea. It may be a reason for the increased resistance towards antibiotics in the community. It is tough to maintain the balance between small benefits and small harms of antibiotics in children (Del Mar, Venekamp and Sanders, 2015). The cause has been determined, however, the possibilities of further development always leave a ray of hope towards the better treatment of the disease. Further research in every possible aspect of the disorder must be done in order discover the unexplored territories of the disease.
Management
Accurate focus to distinguish among the types of Otitis Media is necessary for successful diagnosis of the disease. Generally, it is found that the antibiotic treatment is favorable in case of Otitis Media. However, before proceeding to antibiotic based treatment possible there can be a simple testing to check the effectiveness of the antibiotic on the pathogens. Based on the results, formulation, dosing schedule and treatment duration can be planned. For Otitis Media pathogens, the prevalence of antibiotic resistance is increasing continually and their susceptibility profiles are also changing. It is understood that much remains to be learned about the management of Otitis media. Continuous ongoing research is necessary to understand this common childhood problem. It may as well lead to revision in the already existing opinions about the disease.
Further many of the reports suggests that most of the cases associated with otitis media resolve spontaneously and antibiotic therapy is necessarily not required (Van Buchem et al, 1981). The spontaneous rate of improvement in case of otitis media is high and in such cases large sample size is required, which in turn requires enough power to demonstrate whether the effect of two different interventions is comparable. The so far published literature provides very little guidance about the superiority of one antibiotic or antimicrobial agent in comparison to the other. Even if the superiority among the drugs is determined, still the question remains unanswered, whether the treatment is successful in every possible scenario.? Every coin has two phases. Similarly, positive and negative aspects are associated with every possible disease treatment. The success of a treatment depends upon the fact that how much knowledge and understanding has been gained in relation to the specific context. Funding is a prime concern when designing experiments to be conducted for plausible results towards the better treatment. Furnishing all these requirements at the right place, and putting some effort in the right direction can lead to a promising result.
Conclusion
Otitis media affects millions of children around the world annually continuously with associated complications. High index of efficiency and suspicion is necessary to ensure prompt diagnosis and treatment to reduce the occurrence of complications. As far as complications are associated it is found that this disease has a lack of knowledge because of which a proper treatment is unavailable. Any treatment without proper research does not have any prominence as it has some or the other hitches associated with them. Every disease is an ocean of unexpected results. Adding to the effect, disease resistance is another issue which is increasing on daily basis. Research is required to identify and address the issues concerned with the disease. For every research or experiment conducted the outcome would be possibly towards making the result better than the existing modes of treatment. Funding is the major concern that affects research concerned with any field. A proper and efficient research requires enough funding to carry out and cover the major aspects concerned with the research. The development of a better strategy in concern with the research requires financial grants. The financial assistance is provided based on the originality and novelty of the idea. Otitis Media is a disorder which affects 1 in 10 children annually, which is 10 times more the number of adults affected by the same disease. According to a recent study, it accounts for about 8 % of the total childhood diseases. Chronic form of the disease with effusion causes hearing impairment in about 5% of the five-year old. It is one of the most commonly occurring disease whose reoccurrence is also very prominent. A disease of such kind should be given importance and funding to decrease the possibility of its reoccurrence. Spontaneous and regular work in the field of otitis media will ensure to give us quantitative and qualitative results in form of enhanced therapies with less or no complications. Annually many children are suffering from this disease and it is necessary to find a solution to this problem. In this concern, it is important to understand the underlying causes and design a targeted therapy to avoid the reoccurrence of the disease in any child.
Author
Year
Journal (Source)
Key Findings
Notes
Haidar. H
2017
Journal of otolaryngology
The pathogens associated with Otitis Media.
Otitis is primarily caused by Streptococcus, Haemophilus or Moraxella.
Del Mar, et al
2015
JAMA
The balance between disease reoccurrence and treatment is addressed.
Even after d ministering antibiotics cases of reoccurrence are reported.
Ilechukwu. G, et al
2014
Open journal of paediatrics
The primarily affected age group
Primarily children between the 6 to 36 months are more prone to the disease.
Chonmaitree. T
2006
Clinical infectious diseases
Viruses also cause Otitis media
The disease caused is not purely bacterial. Viruses may also cause a coinfection resulting in Otitis Media.
Bibliography
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Chonmaitree, T. (2006). Acute Otitis Media Is Not a Pure Bacterial Disease. Clinical Infectious Diseases, 43(11), pp.1423-1425.
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