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Acute-Phase Reactants and Acute Bacterial Otitis Media

Mark A. Del Beccaro, MD; Paul M. Mendelman, MD; Andrew F. Inglis, MD; Mark A. Richardson, MD; Newton O. Duncan, MD; Richard P. Shugerman, MD
Am J Dis Child. 1992;146(9):1037-1039. doi:10.1001/archpedi.1992.02160210039017.
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• Objective.  —To determine if the erythrocyte sedimentation rate and C-reactive protein level are elevated in uncomplicated acute bacterial otitis media.

Design.  —Investigator-blinded, antibiotic efficacy trial.

Setting.  —The emergency department of an urban regional children's hospital with 24 000 annual visits.

Participants.  —Thirty-one children with symptoms of acute bacterial otitis media of 7 days' duration or less.

Selection Procedure.  —Volunteer sample.

Interventions.  —Tympanocentesis, oral antibiotics for 10 days, and three follow-up visits in the next 30 days.

Measurements/Results.  —The erythrocyte sedimentation rate and C-reactive protein level were obtained at time of entry into the antibiotic study. Seventeen patients (55%; 95% confidence interval, 37% to 72%) had either an erythrocyte sedimentation rate above 20 mm/h or a C-reactive protein level above 8 mg/L. Eleven patients (35%) had a recurrent episode of acute bacterial otitis media during the follow-up period. The relative risk of recurrence of otitis media given an elevated erythrocyte sedimentation rate or C-reactive protein level was 8.24 (95% confidence interval, 1.20 to 56.74; Fisher's Exact Test; P=.007).

Conclusions.  —Clinicians who use elevated acute-phase reactants as possible indicators of invasive bacterial infections should be aware that an elevated erythrocyte sedimentation rate or C-reactive protein level is also consistent with acute bacterial otitis media. An elevated erythrocyte sedimentation rate or C-reactive protein level also appears to be associated with an increased risk of recurrence of acute bacterial otitis media. If these findings can be confirmed in a larger study, the erythrocyte sedimentation rate or C-reactive protein level could be used to assess the risk of recurrent otitis media.(AJDC. 1992;146:1037-1039)

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