Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial.

OBJECTIVE

To examine whether xylitol, which reduces the growth of Streptococcus pneumoniae, might have clinical importance in the prevention of acute otitis media.

DESIGN

A double blind randomised trial with xylitol administered in chewing gum.

SETTING

Eleven day care nurseries in the city of Oulu. Most of the children had had problems with recurrent acute otitis media.

SUBJECTS

306 day care children: 149 children in the sucrose group (76 boys; mean (SD) age 4.9 (1.5) years) and 157 in the xylitol group (80 boys; 5.0 (1.4) years).

INTERVENTION

Either xylitol (8.4 g a day) or sucrose (control) chewing gum for two months.

MAIN OUTCOME MEASURES

The occurrence of acute otitis media and antimicrobial treatment received during the intervention and nasopharyngeal carriage of S pneumoniae.

RESULTS

During the two month monitoring period at least one event of acute otitis media was experienced by 31/149 (20.8%) children who received sucrose compared with 19/157 (12.1%) of those receiving chewing gum containing xylitol (difference 8.7%; 95% confidence interval 0.4% to 17.0%; P = 0.04). Significantly fewer antimicrobials were prescribed among those receiving xylitol: 29/157 (18.5%) children had at least one period of treatment versus 43/149 (28.9%) (difference 10.4%; 0.9% to 19.9%; P = 0.032). The carriage rate of S pneumoniae varied from 17.4% to 28.2% with no difference between the groups. Two children in the xylitol group experienced diarrhoea, but no other adverse effects were noted among the xylitol users.

CONCLUSION

Xylitol seems to have a preventive effect against acute otitis media.