A Novel Use of Xylitol Sugar in Preventing Acute Otitis Media

American Academy of Pediatrics (AAP) - Tập 102 Số 4 - Trang 879-884 - 1998
Matti Uhari1, Tero Kontiokari1, Marjo Renko1
11 From the Department of Pediatrics, University of Oulu, Oulu, Finland.

Tóm tắt

Background. Xylitol, a commonly used sweetener, is effective in preventing dental caries. As it inhibits the growth of pneumococci, we evaluated whether xylitol could be effective in preventing acute otitis media (AOM). Design. Altogether, 857 healthy children recruited from day care centers were randomized to one of five treatment groups to receive control syrup (n = 165), xylitol syrup (n = 159), control chewing gum (n = 178), xylitol gum (n = 179), or xylitol lozenge (n = 176). The daily dose of xylitol varied from 8.4 g (chewing gum) to 10 g (syrup). The design was a 3-month randomized, controlled trial, blinded within the chewing gum and syrup groups. The occurrence of AOM each time the child showed any symptoms of respiratory infection was the main outcome. Results. Although at least one event of AOM was experienced by 68 (41%) of the 165 children who received control syrup, only 46 (29%) of the 159 children receiving xylitol syrup were affected, for a 30% decrease (95% confidence interval [CI]: 4.6%–55.4%). Likewise, the occurrence of otitis decreased by 40% compared with control subjects in the children who received xylitol chewing gum (CI: 10.0%–71.1%) and by 20% in the lozenge group (CI: −12.9%–51.4%). Thus, the occurrence of AOM during the follow-up period was significantly lower in those who received xylitol syrup or gum, and these children required antimicrobials less often than did controls. Xylitol was well tolerated. Conclusions. Xylitol sugar, when given in a syrup or chewing gum, was effective in preventing AOM and decreasing the need for antimicrobials.

Từ khóa


Tài liệu tham khảo

Gates, 1996, Cost-effectiveness considerations in otitis media treatment., Otolaryngol Head Neck Surg., 114, 525, 10.1016/S0194-5998(96)70243-7

Berman, 1984, Theoretical cost effectiveness of management options for children with persisting middle ear effusions., Pediatrics., 93, 353, 10.1542/peds.93.3.353

Teele, 1990, Otitis media in infancy and intellectual ability, school achievement, speech, and language at age 7 years., J Infect Dis., 162, 685, 10.1093/infdis/162.3.685

Luotonen, 1996, Recurrent otitis media during infancy and linguistic skills at the age of nine years., Pediatr Infect Dis J., 15, 854, 10.1097/00006454-199610000-00005

Paradise, 1990, Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement., JAMA., 263, 2066, 10.1001/jama.1990.03440150074029

Casselbrant, 1992, Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media—results of a randomized clinical trial., Pediatr Infect Dis J., 11, 278, 10.1097/00006454-199204000-00004

Mandel, 1996, Efficacy of antimicrobial prophylaxis for recurrent middle ear effusion., Pediatr Infect Dis J., 15, 1074, 10.1097/00006454-199612000-00004

Roark, 1997, Continuous twice daily or once daily amoxicillin prophylaxis compared with placebo for children with recurrent acute otitis media., Pediatr Infect Dis J., 16, 376, 10.1097/00006454-199704000-00008

Williams, 1993, Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion—a meta-analytic attempt to resolve the brouhaha., JAMA., 270, 1344, 10.1001/jama.1993.03510110084037

Reichler, 1992, The spread of multiply resistant Streptococcus pneumoniae at a day care center in Ohio., J Infect Dis., 166, 1346, 10.1093/infdis/166.6.1346

Arason, 1996, Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study., Br Med J., 313, 387, 10.1136/bmj.313.7054.387

Seppälä, 1997, The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland., N Engl J Med., 337, 441, 10.1056/NEJM199708143370701

Muehlemann, 1970, The effect on rat fissure caries of xylitol and sorbitol., Helv Odont Acta., 14, 48

Mäkinen, 1995, Xylitol chewing gums and caries rates: a 40-month cohort study., J Dent Res., 74, 1904, 10.1177/00220345950740121501

Knuuttila, 1975, Effect of xylitol on the growth and metabolism of Streptococcus mutans., Caries Res., 9, 177, 10.1159/000260156

Kontiokari, 1995, Effect of xylitol on growth of nasopharyngeal bacteria in vitro., Antimicrob Agents Chemother., 39, 1820, 10.1128/AAC.39.8.1820

Uhari, 1996, Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial., Br Med J., 313, 1180, 10.1136/bmj.313.7066.1180

Jerger, 1970, Clinical experience with impedance audiometry., Arch Otolaryngol., 92, 311, 10.1001/archotol.1970.04310040005002

Koivunen, 1997, Minitympanometry in detecting middle ear fluid., J Pediatr., 131, 419, 10.1016/S0022-3476(97)80068-6

Karma, 1987, Finnish approach to the treatment of acute otitis media. Report of the Finnish consensus conference., Ann Otol Rhinol Laryngol, 96, 1, 10.1177/00034894870960S201

Winter, 1996, What about the ethics?, Br Med J, 313, 1183, 10.1136/bmj.313.7066.1183

Kontiokari, 1998, Antiadhesive effects of xylitol on otopathogenic bacteria., J Antimicrob Chemother., 41, 563, 10.1093/jac/41.5.563

Åkerblom, 1982, The tolerance of increasing amounts of dietary xylitol in children., Int J Vitam Nutr Res., 22, 53

Thông tin
Thông tin xuất bản

American Academy of Pediatrics (AAP)

Tập 102 Số 4

879-884

Thông tin tác giả