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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.

Abstract
• 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)

Author Affiliations
From the Children's Hospital and Medical Center, Seattle, Wash (Drs Del Beccaro, Mendelman, Inglis, Richardson, Duncan, and Shugerman) and the Departments of Pediatrics (Drs Del Beccaro, Mendelman, and Shugerman) and Otolaryngology (Drs Inglis, Richardson, and Duncan), University of Washington, Seattle. Dr Mendelman is currently at Merck Research Laboratories, West Point, Pa. Dr Duncan is currently at Baylor University School of Medicine, Houston, Tex.

Footnotes
Accepted for publication May 11, 1992.

Reprint requests to Emergency Services, Children's Hospital and Medical Center, PO Box C5371 MS CH-04, Seattle, WA 98105 (Dr Del Beccaro).

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