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Ameli F, Tosca MA, Ciprandi G. Allergy is not a risk factor for recurrent acute otitis media: a real-life clinical experience. Asia Pac Allergy 2021; 11:e15. [PMID: 34007825 PMCID: PMC8103008 DOI: 10.5415/apallergy.2021.11.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/18/2021] [Indexed: 11/04/2022] Open
Abstract
Background Acute otitis media (AOM) is the most common bacterial infection in children. Some children with AOM tend to be otitis-prone, such as to have frequent recurrence of AOM (RAOM). The possible RAOM risk factors are widely debated. Objective The aim was to identify predictive factors, including clinical data and endoscopic findings, for RAOM in children. Methods The current study was performed in a real-life setting, such as an otorhinolaryngologic (ORL) clinic. In this study, 1,002 children (550 males, 452 females; mean age, 5.77 ± 1.84 years), complaining upper airway symptoms, were consecutively visited. Detailed clinical history and nasal endoscopy were performed. Results Throughout the ORL visit, it was possible to define some factors involved in the recurrence of AOM, including female sex, artificial feeding, tonsillar and adenoid hypertrophy, whereas male sex and recurrent respiratory infections could protect from RAOM. Conclusion Allergy was not associated with RAOM. In addition, this real-life study identified some predictive factors of RAOM, thus also in a primary care setting it is possible to achieve important information that is relevant in clinical practice.
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Affiliation(s)
- Franco Ameli
- Otorhinolaryngology Unit, Casa di Cura Villa Montallegro Health, Genoa, Italy
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Tarantino V, Savaia V, D'Agostino R, Damiani V, Ciprandi G. Oral bacteriotherapy in children with recurrent respiratory infections: a real-life study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:73-76. [PMID: 32073565 PMCID: PMC7947738 DOI: 10.23750/abm.v91i1-s.9230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 11/25/2022]
Abstract
Children with recurrent respiratory infections (RRI) represent a social issue for the economic burden and the familiar negative impact. Bacteriotherapy, such as the administration of “good” bacteria, is a new therapeutic strategy that could be potentially effective in preventing infections. The current study tested the hypothesis of preventing RRI by oral Bacteriotherapy in a real-life setting. This open study was conducted in an outpatient clinic, enrolling 51 children (27 males, mean age 4.8 ± 2.6 years) suffering from RRI. Children were treated with an oral spray, containing Streptococcus salivarius 24SMB and Streptococcus oralis89a (125 x 109 CFU/g), 2 puffs per os once/day for 30 consecutive days; this course was repeated for 3 months. The evaluated parameters were: RI number and school absences reported in the current year; these outcomes were compared with those recorded in the past year. The mean number of RI significantly diminished: from 5.17 (2.30) in the past year to 2.25 (2.43) after the treatment (p<0.0001). The mean number of school absences significantly diminished (from 3.35 to 1.86; p<0.0001). In conclusion, this real-life study suggests that oral Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis89a could efficaciously and safely prevent RRI in children. (www.actabiomedica.it)
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Affiliation(s)
- Vincenzo Tarantino
- Dipartimento Testa-Collo e Neuroscienze - IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Valentina Savaia
- Dipartimento Testa-Collo e Neuroscienze - IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Roberto D'Agostino
- Dipartimento Testa-Collo e Neuroscienze - IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Varricchio A, La Mantia I, Brunese FP, Ciprandi G. Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies. Ital J Pediatr 2020; 46:18. [PMID: 32039733 PMCID: PMC7008537 DOI: 10.1186/s13052-020-0782-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/29/2020] [Indexed: 12/24/2022] Open
Abstract
The upper airways (UA) should be considered as a functional unit. Current functional anatomy divides URT in three, mutually dependent, "junction boxes": i) the ostio-meatal complex (OMC), ii) the spheno-ethmoidal recess (SER), and iii) the rhinopharynx (RP). Correct ventilation and effective mucociliary clearance of these sites significantly affect the healthy physiology of the entire respiratory system. The OMC, SER, and RP obstruction is the first pathogenic step in the inflammatory/infectious cascade of UA disorders. The inflammation of the respiratory mucosa is the main pathogenic factor for airway obstruction. Moreover, bacterial biofilm (a strategy modality of bacterial survival) is an important local cause of systemic antibiotic ineffectiveness, recurrent infections, and antibiotic resistance. Health microbiota guarantees UA wellness; on the contrary, dysbiosis promotes and worsens UA infections. Allergy, namely type 2 inflammation, is a common cause of UA obstruction such as promoting in turn infections. Fiberoptic endoscopy is a mandatory diagnostic tool in clinical practice. Nasal cytology, mainly concerning flow cytometry, allows defining rhinitis phenotypes so allowing a precision medicine approach. Several conventional therapeutic approaches are available, but efficacy and safety should be ever properly considered before the prescription. Also, complementary medicine plays a fruitful role in the management of UA diseases. National and real-world studies are reported and discussed as they may be useful in daily clinical practice.
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Affiliation(s)
- Attilio Varricchio
- UOSD Video-Endoscopia delle VAS, P.O. San Gennaro - ASL Napoli 1-centro, Naples, Italy
| | | | | | - Giorgio Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Via Boselli 5, 16146, Genoa, Italy.
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Abstract
BACKGROUND Over-treatment of acute otitis media (AOM) with antibiotics is common, and poses a high burden on health-care systems. METHODS Records of children 6-36 months of age with AOM visiting a university-affiliated pediatric emergency department between 2014 and 2016 were reviewed for the treatment given: watchful waiting versus antibiotics. If antibiotics were prescribed, the type and duration were recorded. We evaluated appropriate and inappropriate treatment rates of eligible AOM cases, in respect to the local guidelines, which encourage watchful waiting in most mild-moderate cases. RESULTS Out of 1493 AOM visits, 863 (57.8%) were boys, with a median age of 14.9 months (interquartile range, 9-19). The overall pre-visit antibiotic rate was 24.1%, but among those children examined by a physician, this rate was 95.2%. Amoxicillin was the most common antibiotic, administered in 66.3% of the cases. Only 21 children (5.8%) had been treated with antibiotics for ≥7 days before their visit, and were considered as treatment failure. Antibiotic therapy upon discharge was recorded in 1394/1449 visits (96.2%), again with amoxicillin as the most common antibiotic therapy, in 80.8% of the cases. In these visits, the average duration of antibiotic treatment was 8.29 days. Appropriateness of treatment (watchful waiting or antibiotics) could be analyzed in 1134 visits; 20.9% were considered as inappropriate. Of them, 98.3% were prescribed with the wrong antibiotic type and duration. CONCLUSIONS Adherence rate to the local guidelines treatment recommendations for uncomplicated AOM was high, as measured by whether appropriate treatment was given and type and duration of antibiotics.
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Büyükcam A, Kara A, Bedir T, Gülhan B, Özdemir H, Sütçü M, Düzgöl M, Arslan A, Tekin T, Çelebi S, Kukul MG, Bayhan Gİ, Köşker M, Karbuz A, Çelik M, Kocabay Sütçü Z, Metin Ö, Karakaşlılar S, Dağlı A, Kara SS, Albayrak E, Kanık S, Tezer H, Parlakay A, Çiftci E, Somer A, Devrim İ, Kurugöl Z, Dinleyici EÇ, Atla P. Pediatricians' attitudes in management of acute otitis media and ear pain in Turkey. Int J Pediatr Otorhinolaryngol 2018; 107:14-20. [PMID: 29501295 DOI: 10.1016/j.ijporl.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Acute otitis media (AOM) is predominantly a disease of childhood and one of the common reasons for prescribing antibiotics. Ear pain is the main symptom of AOM, with the result that parents frequently seek immediate medical assistance for their children. Antibiotic therapy for AOM does not provide symptomatic relief in the first 24 hours, and analgesics are commonly recommended for relieving the pain associated with AOM. The aims of the present study were to assess pediatricians' attitudes toward AOM and ear pain management in Turkey. METHODS This multicenter descriptive questionnaire study was conducted in 20 centers from different geographic locations in Turkey, with 977 pediatricians, between June 2015 and December 2016. The questionnaire comprised 20 questions focusing on the pediatricians' sociodemographic variables, experiences, and treatment related to AOM and ear pain. RESULTS Of the pediatricians, 58.2% were residents, 36.5% were specialists, and 4.3% were lecturers. Most participants were working in a university hospital (54.8%) or education and research hospital (32.2%). In general daily practice, the AOM diagnosis rates were between 6% and 20% in outpatient clinics, and 52.3% of the participants stated the patients complained about ear pain in pediatric clinics. The watchful waiting (WW) rate, as opposed to immediate antibiotic treatment, was 39.8% for all the pediatricians. The pediatric residents used the WW strategy less than the specialists and lecturers did (p = 0.004). The rates of the WW strategy were higher in outpatient clinics where AOM was commonly diagnosed (p < 0.001). The most common antibiotic prescribed for AOM was amoxicillin clavulanate (76.7%). The mean recommended treatment period for AOM was 9.3 ± 2.2 days. The choices for systemic ear pain treatment were acetaminophen (26.8%), ibuprofen (29.4%), and alternating between ibuprofen and acetaminophen (43.9%). Moreover, 34.6% of the participants recommended topical agents for otalgia. Topical agents were more commonly recommended by the pediatric residents than specialists or lecturers (p < 0.001). Finally, 58.3% of pediatricians had experiences of the parents' usage of a variety of herbal and folk remedies, such as breast milk or olive oil, for their children's ear pain. CONCLUSION Amoxicillin clavulanate was the most frequently prescribed antibiotic for AOM. WW was approved by the pediatricians, and having more AOM patients was a significant factor in the physicians' choice of WW; nevertheless, the WW rate was poor. Implementation of educational intervention strategies will help pediatricians in improving their compliance with evidence-based guidelines for AOM treatment. Otalgia is taken seriously by parents and pediatricians, and otalgia treatment seems to be well accepted in Turkey for providing symptomatic relief and enhancing the patients' quality of life.
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Affiliation(s)
- Ayşe Büyükcam
- Hacettepe University, Pediatric Infection Department, Ankara, Turkey.
| | - Ateş Kara
- Hacettepe University, Pediatric Infection Department, Ankara, Turkey
| | - Tuğba Bedir
- Gazi University, Pediatric Infection Department, Ankara, Turkey
| | - Belgin Gülhan
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infection Department, Ankara, Turkey
| | - Halil Özdemir
- Ankara University, Pediatric Infection Department, Ankara, Turkey
| | - Murat Sütçü
- İstanbul University, Pediatric Infection Department, İstanbul, Turkey
| | - Mine Düzgöl
- Behçet Uz Training and Research Hospital, Pediatric Infection Department, İzmir, Turkey
| | - Aslı Arslan
- Ege University, Department of Pediatrics, İzmir, Turkey
| | - Tuna Tekin
- Eskişehir University, Department of Pediatrics, Eskişehir, Turkey
| | - Solmaz Çelebi
- Uludağ University, Pediatric Infection Department, Bursa, Turkey
| | - Musa Gürel Kukul
- Hacettepe University, Pediatric Infection Department, Ankara, Turkey
| | | | - Muhammet Köşker
- Diyarbakır Children Hospital, Pediatric Infection Department Diyarbakır, Turkey
| | - Adem Karbuz
- Okmeydanı Training and Research Hospital, Pediatric Infection Department, İstanbul, Turkey
| | - Melda Çelik
- Keçiöğren Training and Research Hospital, Pediatric Infection Department, Ankara, Turkey
| | - Zümrüt Kocabay Sütçü
- Süleymaniye Maternity and Children Hospital, Department of Pediatrics, İstanbul, Turkey
| | - Özge Metin
- Konya Training and Research Hospital, Pediatric Infection Department, Konya, Turkey
| | | | | | - Soner Sertan Kara
- Erzurum Training and Research Hospital, Pediatric Infection Department, Erzurum, Turkey
| | - Eda Albayrak
- Recep Tayip Erdoğan University, Department of Pediatrics, Rize, Turkey
| | - Saliha Kanık
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infection Department, Ankara, Turkey
| | - Hasan Tezer
- Gazi University, Pediatric Infection Department, Ankara, Turkey
| | - Aslınur Parlakay
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infection Department, Ankara, Turkey
| | - Ergin Çiftci
- Ankara University, Pediatric Infection Department, Ankara, Turkey
| | - Ayper Somer
- İstanbul University, Pediatric Infection Department, İstanbul, Turkey
| | - İlker Devrim
- Behçet Uz Training and Research Hospital, Pediatric Infection Department, İzmir, Turkey
| | - Zafer Kurugöl
- Ege University, Department of Pediatrics, İzmir, Turkey
| | | | - Pınar Atla
- Kırklareli State Hospital, Department of Pediatrics, Kırklareli, Turkey
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La Mantia I, Varricchio A, Ciprandi G. Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray for preventing recurrent acute otitis media in children: a real-life clinical experience. Int J Gen Med 2017; 10:171-175. [PMID: 28684920 PMCID: PMC5484566 DOI: 10.2147/ijgm.s137614] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Recurrence of acute otitis media (RAOM) is a relevant issue in the clinical practice. “Bacteriotherapy” has been proposed as an option in children with RAOM. Streptococcus salivarius 24SMB nasal spray has been previously demonstrated to reduce the risk of acute otitis media (AOM) in otitis-prone children. The current retrospective and observational study aimed to confirm this outcome in a real-life setting, such as the common pediatric practice. Group A (108 children) served as control; group B (159 children) was treated with S. salivarius 24SMB and Streptococcus oralis 89a nasal spray after the first AOM episode. Active treatment consisted of 3 monthly courses: 2 puffs per nostril twice/day for a week. Group B showed a significant reduction of AOM episodes in comparison with group A (p<0.0001). Notably, all actively treated children with the highest AOM recurrence had a reduction of recurrence, whereas only 50% of the control group children had reduced RAOM (p<0.0001). Also, severity grade of AOM significantly diminished after the preventive bacteriotherapy (p<0.0001). In conclusion, the current retrospective and observational study demonstrated that S. salivarius 24SMB and S. oralis 89a nasal spray could be effective in the prevention of RAOM in a real-life setting.
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