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Acute otitis media (AOM) is one of the most common pediatric diseases; almost all children experience at least one episode, and a third have two or more episodes in the first three years of life. The disease burden of AOM has important medical, social and economic effects. AOM requires considerable financial assistance due to needing at least one doctor visit and a prescription for antipyretics and/or antibiotics. AOM is also associated with high indirect costs, which are mostly related to lost days of work for one parent. Moreover, due to its acute symptoms and frequent recurrences, AOM considerably impacts both the child and family’s quality of life. AOM prevention, particularly recurrent AOM (rAOM), is a primary goal of pediatric practice. In this paper, we review current evidence regarding the efficacy of medical treatments and vaccines for preventing rAOM and suggest the best approaches for AOM-prone children.
Financial & competing interests disclosure
This review was supported by a grant from the Italian Ministry of Health (Bando Giovani Ricercatori 2009). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Key issues
Acute otitis media (AOM) is one of the most common pediatric diseases; by the age of 3, almost all children have experienced at least one episode of AOM and a third have experienced two or more episodes.
Recurrent AOM (rAOM) has significant medical, social and economic effects.
Medical interventions for rAOM prevention are still far from optimal since no current medical methods can completely reduce the risk for rAOM.
Reducing child-specific factors that are associated with rAOM and can be modified (i.e., daycare attendance, bottle-feeding, secondhand smoke and pacifier use) is the first step in rAOM prevention.
Both pneumococcal conjugate vaccines and influenza vaccines are effective for reducing AOM incidence in the general pediatric population and are strongly recommended; however, their effectiveness in children with rAOM is lower than expected due to a subset of children with rAOM who have a reduced vaccination immune response.
Oral and topical probiotics, xylitol, vitamin D and complementary and alternative medicine remain intriguing options for rAOM prophylaxis, but current data are insufficient for recommending their use.
Antibiotics remain a good method for rAOM prevention; however, the risk of microbial selection means they should be used with caution.
Several rAOM studies have tried to evaluate genetic characteristics associated with rAOM; these studies could identify genetic markers that allow the early identification of AOM-predisposed individuals, allowing preventative measures to be implemented as soon as possible.