Experimental and investigational drugs for the treatment of acute otitis media

ABSTRACT

Introduction: Acute otitis media (AOM) is a common disease, particularly in infants and young children. Almost all children experience at least one episode of AOM in the first 3 years of age, and approximately 50% experience recurrent episodes in the same period of time.

Areas covered: Some new potentially effective preventive or therapeutic approaches to AOM have been identified and are not discussed even in the most updated guidelines. The main aim of this narrative review is to detail what has been recently suggested.

Expert opinion: Several new measures have been suggested to reduce systemic antibiotic abuse in AOM therapy and prophylaxis. For therapy, the administration of preparations containing antibiotics, bacteriophages or peptides can allow trans-tympanic passage of effective anti-otopathogen measures and the use of vaccines or immunoglobulins can disrupt biofilm. For AOM prophylaxis, new vaccines and the use of probiotics by nasal spray are in development. However, further advances in the selection of children for whom antimicrobial therapy and/or prophylaxis measures are truly needed could be derived from studies that analyse the association between genetic characteristics of the host and development of AOM with specific characteristics of aetiology or tendency to recur.

KEYWORDS:

• Acute otitis media
• antibiotic
• bacteriophage
• peptide
• probiotic
• vaccine

Article highlights

• Acute otitis media (AOM) is a common disease, particularly in infants and young children.

• Generally, AOM is a mild disease as it can heal spontaneously in a few days or solve quickly with the administration of an antibiotic active against the causative bacteria. However, complications can occur.

• At the moment the best solution to reduce antibiotic use and related problems is compliance with expert recommendations that accurately select AOM cases for which antibiotics are truly needed and suggest watchful waiting for mild AOM cases, particularly in children < 2 years.

• For AOM therapy, new preparations containing antibiotics, bacteriophages or peptides that can allow trans-tympanic passage of effective anti-otopathogen measures and vaccines or immunoglobulins that can disrupt biofilm are in development.

• For AOM prophylaxis, new vaccines and measures based on the use of probiotics by nasal spray are in development.

• Further advances in the selection of children for whom antimicrobial therapy and/or prophylaxis measures are truly needed could be derived from studies that analyse the association between genetic characteristics of the host and development of AOM with specific characteristics of aetiology or tendency to recur.

This box summarizes key points contained in the article.

Declaration of interest

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.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was funded by the Italian Ministry of Health (Bando Giovani Ricercatori 2009 GR-2009-1596786).