II. Prevention: Recurrent Otitis Media

  1. Influenza Vaccine annually
  2. Pneumococcal Conjugate Vaccine (e.g. Prevnar 13)
    1. Reduces Incidence of pneumococcal Otitis Media
    2. Jacobs (2002) J Pediatr 141:287-93 [PubMed]
  3. Eliminate passive Tobacco smoke exposure
  4. Avoid bottle propping
  5. Avoid Pacifiers
  6. Consider diagnosis and management of comorbid chronic Allergic Rhinitis
  7. Xylitol gum
    1. Consider in children with recurrent Otitis Media and old enough to chew gum
    2. Chew 2 pieces for at least 5 minutes each, 5 times daily after meals
    3. Azarpazhooh (2011) Cochrane Database Syst Rev (11): CD007095 [PubMed]
  8. Tympanostomy Tube indications
    1. Three Otitis Media episodes in 6 months OR 4 episodes in 1 year AND
    2. Last episode within prior 6 months

III. Prevention: Strategies not found effective (avoid these for Otitis Media Prevention)

  1. Probiotics
    1. Not effective in URI or Otitis Media Prevention
    2. Probiotics are effective to prevent Antibiotic Associated Diarrhea
    3. Weichert (2012) Pediatr Infect Dis 31(8): 859-62 [PubMed]

IV. Protocol: Antibiotic Prophylaxis for Recurrent Otitis Media (not recommended, historical purpose only)

  1. Antibiotic prophylaxis is largely replaced by Tympanostomy Tubes
  2. Antibiotics prophylaxis for recurrent Otitis Media is not recommended
    1. Lieberthal (2013) Pediatrics 131(3): e964-99 [PubMed]
  3. Antibiotic prophylaxis reduced recurrent Otitis Media episodes by 50%, but at the expense of Antibiotic Resistance
    1. Antibiotic prophylaxis selects for antibiotic resistant Streptococcus Pneumoniae
  4. Antibiotics were previously indicated for
    1. Three distinct Otitis Media episodes in 6 months
    2. Four distinct Otitis Media episodes in 12 months
  5. Prior protocols use Amoxicillin or sulfisoxazole for up to 6 months

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