Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed for children in the United States. Previous trials evaluating an optional antibiotic prescription are limited and have significant limitations. None have evaluated an optional prescription in the urgent care setting. We conducted a randomized, controlled trial in an urban emergency department in which children aged 6 months to 12 years diagnosed with AOM were randomly assigned a "wait-and-see prescription" (WASP) or a "standard treatment prescription" (STP). Structured phone interviews were conducted 4-6, 11-14, and 30-40 days after enrollment to determine the proportion of each group that filled the antibiotic prescription and outcomes related to the clinical course. Substantially more parents in the WASP group (N=138) did not fill the antibiotic prescription compared to the STP group (N=145) (62% vs. 13%; P<0.001). There were no statistically significant differences between the groups in the frequency of subsequent fever, otalgia or unscheduled visits for medical care. Within the WASP group, both fever (OR = 4.0, 95% confidence interval, 1.7-9.5) and otalgia (OR = 4.5, 95% confidence interval, 1.7-11.5) were associated with filling the prescription. The WASP approach substantially reduced unnecessary use of antibiotics in children and is a reasonable alternative to routine use of antimicrobials for treatment of AOM.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

No description available.

La otitis constituye un problema muy común representando entre 5 y 20% en la práctica veterinaria diaria. Dentro de las infecciones óticas bacterianas, se ha reportado al Staphylococcus intermedius como el agente causal más importante. El objetivo de este estudio fue determinar la frecuencia mensual, estacional y anual de casos de otitis bacteriana en el periodo 2001-2006 en el laboratorio de bacteriología de la FMV-UNMSM. Asimismo, determinar las especies bacterianas involucradas más comunes y la susceptibilidad de estas a los antibióticos. Los resultados de este estudio indican 429 casos, disminuyendo progresivamente desde el 2001 con 183 casos hasta el 2006 con 26 casos. Por otro lado, las infecciones óticas fueron en su mayoría monomicrobianas siendo el Staphylococcus intermedius, con 27,72%, el agente aislado con mayor frecuencia. Sin embargo, hay que tener en cuenta a importantes agentes como la Pseudomonas aeruginosa, Streptococcus sp. y Staphylococcus sp.. En las pruebas de susceptibilidad por el método de Kirby-Bauer, se encontró el mayor nivel de susceptibilidad de las bacterias a las quinolonas, aminoglucósidos, cefalosporinas y penicilinas combinadas con inhibidores de las betalactamasas. Mientras que las penicilinas, sulfas, tetraciclinas, lincosamidas y macrólidos fueron menos efectivos en inhibir el crecimiento de microorganismos. Palabras Clave: Otitis, susceptibilidad, bacterias. / --- The otitis canine is a common disease, representing from 5 to 20% in a daily veterinary practice. Among the bacterial ear infections has been reported to Staphylococcus intermedius as the most important causative agent. The objective of this study was to determine the frequency monthly, seasonal and annual cases of bacterial otitis in the period 2001-2006 in the bacteriology laboratory of the FMV-UNMSM. Also, identify bacterial species involved and the most common bacterial susceptibility to antibiotics. The results of this study indicate 429 cases, decreasing gradually since 2001 with 183 cases until 2006 with 26 cases. Moreover, the ear infections were mostly caused by one agent being the most frequently agent isolated the Staphylococcus intermedius, with 27.72%. However, we must take in account important agents as Pseudomonas aeruginosa, Streptococcus sp. and Staphylococcus sp.. In susceptibility testing by the Kirby-Bauer method, we found the highest level of bacterial susceptibility to quinolones, aminoglycosides, cephalosporins and penicillins combined with inhibitors of betalactamics. Meanwhile, penicillins, sulfas, tetracyclines, macrolides and lincosamides were less effective in inhibiting the growth of microorganisms. Key Words: Otitis, susceptibility, bacteria.

Otitis Media is one of the most common childhood diseases. Recurrent acute otitis media RAOM is characterized by repeated episodes of inflammation of the middle ear in conjunction with middle ear fluid, and often with an inflamed or bulging eardrum. Defective clearance by the Eustachian tube results in mucus build-up and is characteristic of otitis media with effusion (OME). Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, respiratory syncytial virus, and rhinovirus are the most common contributors to otitis media pathogenesis. In New Zealand, OME has been implicated with conductive hearing loss in childhood and has been shown to significantly impact on speech and language development. New Zealand Māori and Polynesian children have displayed significantly higher hearing test failure rates than European-Caucasian children. The collectins, Surfactant Protein (SP)-A and -D are encoded by three genes (SP-A1, SP-A2, and SP-D) and are host defense proteins present in the middle ear and Eustachian tube. Single nucleotide polymorphisms (SNPs) in SP-A1 and SP-A2 have been associated with increased or decreased susceptibility to otitis media, meningococcal disease, and range of respiratory diseases. Using allele-specific primers and real-time PCR with SYBR Green I melting curve analysis, four groups of individuals were genotyped for eleven SP-A1, SP-A2, and SP-D SNPs: European-Caucasian individuals with RAOM/OME; New Zealand Māori/Polynesian individuals with RAOM/OME; individuals with meningococcal disease; and a control group. The computer program, Haploview, was employed to perform χ2 analyses and identify statistically significant associations of alleles/haplotypes with RAOM/OME or meningococcal disease. In the European-Caucasian population, two SP-A1 alleles, one SP-A2 allele, and four haplotypes (CGAGC, 1A3, 1A9, and 1A10) were found to be associated with increased risk of RAOM/OME (P lt; 0.05). Conversely, haplotypes 6A2 and 1A2 were found to be protective against susceptibility to RAOM/OME (P lt; 0.05). In New Zealand Māori and Polynesian individuals, two SP-A1 alleles, three SP-A2 alleles, one SP-D allele, and four haplotypes (6A8, 6A10, 1A3, and 1A10) were found to be associated with increased risk of RAOM/OME (P lt; 0.05). An additional four haplotypes (6A2, 1A0, 1A2, and TA) were determined to be protective against susceptibility to RAOM/OME (P lt; 0.05). However, protective SPA1/SPA2/SPD haplotype 6A2-1A0-TA was significantly under-represented in the New Zealand Māori and Polynesian population (P lt; 0.05). A single allele and haplotype were associated with increased risk of meningococcal disease (P lt; 0.05). The findings of this study confirm that specific genetic variants of SP-A and SP-D are associated with either increased or decreased risk of developing RAOM and/or OME. Furthermore, it was demonstrated that New Zealand Māori and Polynesian individuals appear to exhibit more haplotypes susceptible to RAOM/OME. This may provide a partial explanation for the higher RAOM/OME-related failure rates of hearing tests in New Zealand Māori and Polynesian children. However, there are numerous socio-economic and environmental factors that also contribute to otitis media pathogenesis which were not considered in this study. The effects of the SP-A1, SP-A2, and SP-D alleles and haplotypes on the bacterial/viral binding efficiencies of SP-A and SP-D need to be investigated by further research, using a large population, to confirm the association with susceptibility or resistance with RAOM/OME.

La otitis constituye un problema muy común representando entre 5 y 20% en la práctica veterinaria diaria. Dentro de las infecciones óticas bacterianas, se ha reportado al Staphylococcus intermedius como el agente causal más importante. El objetivo de este estudio fue determinar la frecuencia mensual, estacional y anual de casos de otitis bacteriana en el periodo 2001-2006 en el laboratorio de bacteriología de la FMV-UNMSM. Asimismo, determinar las especies bacterianas involucradas más comunes y la susceptibilidad de estas a los antibióticos. Los resultados de este estudio indican 429 casos, disminuyendo progresivamente desde el 2001 con 183 casos hasta el 2006 con 26 casos. Por otro lado, las infecciones óticas fueron en su mayoría monomicrobianas siendo el Staphylococcus intermedius, con 27,72%, el agente aislado con mayor frecuencia. Sin embargo, hay que tener en cuenta a importantes agentes como la Pseudomonas aeruginosa, Streptococcus sp. y Staphylococcus sp.. En las pruebas de susceptibilidad por el método de Kirby-Bauer, se encontró el mayor nivel de susceptibilidad de las bacterias a las quinolonas, aminoglucósidos, cefalosporinas y penicilinas combinadas con inhibidores de las betalactamasas. Mientras que las penicilinas, sulfas, tetraciclinas, lincosamidas y macrólidos fueron menos efectivos en inhibir el crecimiento de microorganismos. Palabras Clave: Otitis, susceptibilidad, bacterias. / The otitis canine is a common disease, representing from 5 to 20% in a daily veterinary practice. Among the bacterial ear infections has been reported to Staphylococcus intermedius as the most important causative agent. The objective of this study was to determine the frequency monthly, seasonal and annual cases of bacterial otitis in the period 2001-2006 in the bacteriology laboratory of the FMV-UNMSM. Also, identify bacterial species involved and the most common bacterial susceptibility to antibiotics. The results of this study indicate 429 cases, decreasing gradually since 2001 with 183 cases until 2006 with 26 cases. Moreover, the ear infections were mostly caused by one agent being the most frequently agent isolated the Staphylococcus intermedius, with 27.72%. However, we must take in account important agents as Pseudomonas aeruginosa, Streptococcus sp. and Staphylococcus sp.. In susceptibility testing by the Kirby-Bauer method, we found the highest level of bacterial susceptibility to quinolones, aminoglycosides, cephalosporins and penicillins combined with inhibitors of betalactamics. Meanwhile, penicillins, sulfas, tetracyclines, macrolides and lincosamides were less effective in inhibiting the growth of microorganisms. Key Words: Otitis, susceptibility, bacteria.

This thesis is an investigation of Pseudomonas aeruginosa bacterial biofilms. The objective of the first study was to evaluate the biofilm-forming capacity of canine otitis isolates of P. aeruginosa and to compare the minimum inhibitory concentrations (MICs) of antimicrobials for planktonic versus biofilm-embedded bacteria. Biofilm forming ability was assessed using a microtitre plate assay. Broth microdilution was used to assess the MICs of neomycin, polymyxin B, enrofloxacin and gentamicin for the planktonic and biofilm-embedded bacteria of eighty-three isolates. Thirty-three (40%) isolates were biofilm producers and MICs for biofilm-embedded bacteria were significantly higher than their planktonic counterparts for all antimicrobials (all P<0.05). The objective of the second study was to evaluate the impact of Tromethamine edetate disodium dihydrate (Triz-EDTA®) in combination with antimicrobials on antimicrobial susceptibility of P. aeruginosa biofilm-embedded bacteria. MICs of the four antimicrobials for the biofilm embedded bacteria and biofilm-embedded bacteria with added Triz-EDTA® were assessed with broth microdilution for thirty-one biofilm-producing isolates. Addition of Triz-EDTA® significantly reduced MICs for neomycin (P < 0.008) and gentamicin (P < 0.04) but not enrofloxacin (P = 0.7), or polymyxin B (P = 0.5). The objective of the third study was to determine the presence of biofilm-associated genes in biofilm forming and non-biofilm forming isolates. Four genes involved with carbohydrate matrix production (pelA), irreversible attachment (sadB) and quorum sensing (lasB, rhlA) were selected. DNA was extracted and polymerase chain reaction (PCR) was performed for all isolates. All isolates possessed lasB and sadB, 74 (90%) possessed pelA and 74 (90%) possessed rhlA. All thirty-two (100%) isolates that were classified as biofilm producers contained all genes. There was an association between the presence of pelA and rhlA and biofilm production (P < 0.017) and between the presence of rhlA and pelA and the quantity of biofilm produced (both P < 0.001). These results highlight that biofilm formation of Pseudomonas aeruginosa otic isolates does occur and can impact antimicrobial therapy. Certain compounds can also influence antimicrobial susceptibility of biofilm-embedded bacteria. Genetics may also play a role in biofilm formation.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2008. / Härtill 4 uppsatser.

Thesis (Ph. D.)--School of Biology, Georgia Institute of Technology, 2005. Directed by Paul Edmonds. / Paul Edmonds, Committee Chair ; Steve Harvey, Committee Member ; Igor Zhulin, Committee Member ; Yury Chernoff, Committee Member ; Mostafa El-Sayed, Committee Member. Includes bibliographical references.