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Clinical and Diagnostic Laboratory Immunology, July 2003, p. 721-724, Vol. 10, No. 4
1071-412X/03/$08.00+0     DOI: 10.1128/CDLI.10.4.721-724.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Systemic Inflammatory Responses in Children with Acute Otitis Media Due to Streptococcus pneumoniae and the Impact of Treatment with Clarithromycin

Gunter Scharer,¹ Frank Zaldivar,² Guillermo Gonzalez,³ Ofelia Vargas-Shiraishi,³ Jasjit Singh,³ and Antonio Arrieta^3*

Residency Program,¹ Division of Immunology,² Division of Pediatric Infectious Diseases, Children's Hospital of Orange County, Orange, California³

Received 1 August 2002/ Returned for modification 21 October 2002/ Accepted 19 March 2003

This pilot study was designed to determine the serum cytokine profile of acute otitis media (AOM) due to Streptococcus pneumoniae and the impact of clarithromycin (Abbott Laboratories, Inc). Serum levels of interleukin-1ß (IL-1ß), tumor necrosis factor alpha (TNF-), IL-6, and IL-8 were measured at diagnosis and 3 to 5 days after start of antibiotic treatment in 10 patients (mean age, 18.3 ± 13.9 months) who had middle ear fluid culture positive for S. pneumoniae. The mean concentrations of all cytokines were elevated at diagnosis of AOM compared to levels in healthy controls, yet only IL-6 reached statistical significance (P = 0.05). IL-6 showed a statistically significant decrease in mean serum concentration at visit 2 (P = 0.03). IL-8 displayed a similar pattern to IL-6, but the difference between samples from day 1 and day 2 did not reach statistical significance. The cytokines IL-1ß and TNF- appear to be elevated in the serum of patients with S. pneumoniae AOM, but there was no significant change between mean serum levels obtained pre- and postinitiation of antibiotic treatment in the time frame studied. The results suggest a systemic inflammatory response as evidenced by increased IL-6. A significant decrease of IL-6 and improvement of clinical symptoms were observed. Determining cytokine levels, especially IL-6, in AOM could offer a powerful tool for objective assessment of response to treatment, minimizing unnecessary treatment of asymptomatic children who may still have some otoscopic findings suggestive of AOM at follow-up visits.

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* Corresponding author. Mailing address: Division of Pediatric Infectious Diseases, Children's Hospital of Orange County, 455 S. Main St., Orange, CA 92868. Phone: (714) 532-8403. Fax: (714) 289-4014. E-mail: aarrrieta{at}choc.org.

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Clinical and Diagnostic Laboratory Immunology, July 2003, p. 721-724, Vol. 10, No. 4
1071-412X/03/$08.00+0     DOI: 10.1128/CDLI.10.4.721-724.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

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