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

机译：肺炎链球菌引起的急性中耳炎患儿的全身炎症反应及克拉霉素治疗的影响

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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-1β (IL-1β), tumor necrosis factor alpha (TNF-α), 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-1β and TNF-α 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.
机译：这项初步研究旨在确定由于肺炎链球菌引起的急性中耳炎（AOM）和克拉霉素的影响的血清细胞因子谱（Abbott Laboratories，Inc）。在诊断时和开始抗生素治疗后3到5天测量了10例患者的白细胞介素1β（IL-1β），肿瘤坏死因子α（TNF-α），IL-6和IL-8的血清水平（平均年龄） （18.3±13.9个月），其中中耳液培养的肺炎链球菌呈阳性。与健康对照组相比，AOM诊断时所有细胞因子的平均浓度均升高，但只有IL-6达到统计学意义（P = 0.05）。 IL-6在第2次就诊时的平均血清浓度显示出统计学上的显着降低（P = 0.03）。 IL-8显示与IL-6相似的模式，但第1天和第2天的样品之间的差异未达到统计学意义。肺炎链球菌AOM患者血清中的细胞因子IL-1β和TNF-α似乎升高，但在所研究的时间范围内，在开始抗生素治疗前后前后获得的平均血清水平之间没有显着变化。结果表明全身炎症反应，如IL-6增加所证明。观察到IL-6的显着降低和临床症状的改善。确定AOM中的细胞因子水平，尤其是IL-6，可以为客观评估治疗反应提供强大的工具，从而最大程度地减少对无症状儿童的不必要治疗，这些儿童在随访时仍可能有一些耳镜检查结果提示AOM。

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