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

BMJ 1996;313:1180-1183 (9 November)

Papers

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

M Uhari, associate professor,^a T Kontiokari, research fellow,^a M Koskela, head of division,^b Marjo Niemela, research fellow ^a

^a Department of Paediatrics, University of Oulu, FIN-90220 Oulu, Finland, ^b Division of Microbiology, University Hospital of Oulu, FIN-90220 Oulu, Finland

Correspondence to: Professor Uhari.

Abstract

Objective: To examine whether xylitol, which reduces the growthof Streptococcus pneumoniae, might have clinical importancein the prevention of acute otitis media.
Design: A double blind randomised trial with xylitol administeredin chewing gum.
Setting: Eleven day care nurseries in the city of Oulu. Mostof the children had had problems with recurrent acute otitismedia.
Subjects: 306 day care children: 149 children in the sucrosegroup (76 boys; mean (SD) age 4.9 (1.5) years) and 157 in thexylitol 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 mediaand antimicrobial treatment received during the interventionand nasopharyngeal carriage of S pneumoniae.
Results: During the two month monitoring period at least oneevent of acute otitis media was experienced by 31/149 (20.8%)children who received sucrose compared with 19/157 (12.1%) ofthose receiving chewing gum containing xylitol (difference 8.7%;95% confidence interval 0.4% to 17.0%; P = 0.04). Significantlyfewer antimicrobials were prescribed among those receiving xylitol:29/157 (18.5%) children had at least one period of treatmentversus 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 childrenin the xylitol group experienced diarrhoea, but no other adverseeffects were noted among the xylitol users.
Conclusion: Xylitol seems to have a preventive effect againstacute otitis media.

Key messages

It also inhibits the growth of S pneumoniae
When given to children with recurrent otitis mediain chewing gum xylitol reduced the occurrence of otitis media by about 40%
The daily dose required is not known, but 8.4 g given daily in a chewing gum seems to be effective
Xylitol had no effect on the nasopharyngeal car- riage of pneumococci

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