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Outcome evaluation of clarithromycin, metronidazole and lansoprazole regimens in Helicobacter pylori positive or negative children with resistant otitis media with effusion

Published online by Cambridge University Press:  15 February 2016

S S Bakshi*
Affiliation:
Department of ENT and Head and Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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Abstract

Type
Letters to the Editors
Copyright
Copyright © JLO (1984) Limited 2016 

Dear Editors,

I came across a very interesting study published in your prestigious journal titled ‘Outcome evaluation of clarithromycin, metronidazole and lansoprazole regimens in Helicobacter pylori positive or negative children with resistant otitis media with effusion’ by Mel-Hennawi et al.Reference Mel-Hennawi and Ahmed1 The authors have conducted a very meticulous study and I would like to appreciate their effort; however, I have some concerns regarding the methodology and conclusion, which I would like to express through your esteemed journal.

The role of H pylori in the pathogenesis of otitis media with effusion (OME) is a matter of debate, with studies both in favour of itReference Yilmaz, Ceylan, Akyön, Ozçakýr and Gürsel2 and against it.Reference Sudhoff, Rajagopal, Baguley, Ebmeyer, Schmelzer and Schreiber3 The aspirated fluid from the middle ear has been used for the detection of H pylori in most of the studies as it is confirmatory for the presence of the bacteria in the middle ear. However, in the present study only the stool antigen has been used. The detection of H pylori in stool samples, although cheap and non-invasive, does not confirm the presence of the bacteria in the middle ear. In addition, the prevalence of H pylori in children ranges from 15 to 70 per cent;Reference Oderda, Marietti and Pellicano4 therefore, the detection of H pylori in stool samples is non-specific and may not be significant.

A few studies have explored the role of gastroesophageal reflux in the pathogenesis of otitis media.Reference Doğru, Kuran, Haytoğlu, Dengiz and Arıkan5 In such a scenario, it is possible that the children in the present study could have benefitted primarily from a reduction in the gastroesophageal reflux by lansoprazole. This needs to be proven in future prospective trials. If proven, then clarithromycin and metronidazole can be omitted, thereby reducing the cost of treatment and avoiding the side effects of these antibiotics.

A further concern is the rising incidence of development of clarithromycin resistance in H pylori. Therefore, misuse of clarithromycin should be prevented at all costs, and its use should be based on clear scientific evidence. The evidence for the use of clarithromycin in OME is still unclear. Future randomised, controlled trials with larger sample populations are warranted before a conclusion can be drawn.

References

1Mel-Hennawi, D, Ahmed, MR.Outcome evaluation of clarithromycin, metronidazole and lansoprazole regimens in Helicobacter pylori positive or negative children with resistant otitis media with effusion. J Laryngol Otol 2015;129:1069–72CrossRefGoogle ScholarPubMed
2Yilmaz, T, Ceylan, M, Akyön, Y, Ozçakýr, O, Gürsel, B.Helicobacter pylori: a possible association with otitis media with effusion. Otolaryngol Head Neck Surg 2006;134:772–7CrossRefGoogle ScholarPubMed
3Sudhoff, H, Rajagopal, S, Baguley, DM, Ebmeyer, J, Schmelzer, A, Schreiber, S et al. A critical evaluation of the evidence on a causal relationship between Helicobacter pylori and otitis media with effusion. J Laryngol Otol 2008;122:905–11CrossRefGoogle ScholarPubMed
4Oderda, G, Marietti, M, Pellicano, R.Diagnosis and treatment of helicobacter pylori infection in pediatrics: recommendation for 2014 clinical practice [in Italian]. Minerva Pediatr 2015;67:517–24Google Scholar
5Doğru, M, Kuran, G, Haytoğlu, S, Dengiz, R, Arıkan, OK.Role of laryngopharyngeal reflux in the pathogenesis of otitis media with effusion. J Int Adv Otol 2015;11:6671CrossRefGoogle ScholarPubMed