Vitamin D Supplementation Reduces the Risk of Acute Otitis Media in Otitis-prone Children

Background: The aim of this study was to evaluate whether a deficit in vitamin D (VD) is associated with an increased risk of recurrent acute otitis media (AOM) and whether VD supplementation is effective in reducing the number of AOM episodes in otitis-prone children. Methods: A total of 116 children with a history of recurrent AOM (≥3 episodes in preceding 6 months or ≥4 episodes in preceding 12 months) were prospectively and blindly randomized to receive oral VD 1000 IU/d or placebo for 4 months. Episodes of AOM were monitored for 6 months. Results: Fifty-eight children received placebo and 58 with similar characteristics were treated with VD. The number of children experiencing ≥1 AOM episode during the study period was significantly lower in the treatment group (26 versus 38; P = 0.03). There was a marked difference in the number of children who developed uncomplicated AOM (P < 0.001), but no difference in the number of children with ≥1 episode of spontaneous otorrhea. The likelihood of AOM was significantly reduced in the patients whose serum VD concentrations were ≥30 ng/mL. Conclusions: VD hypovitaminosis is common in children with recurrent AOM and associated with an increase in the occurrence of AOM when serum 25(OH)D levels are <30 ng/mL. The administration of VD in a dosage of 1000 IU/d restores serum values of ≥30 ng/mL in most cases and is associated with a significant reduction in the risk of uncomplicated AOM.

[1]  S. Esposito,et al.  A retrospective evaluation of microbiology of acute otitis media complicated by spontaneous otorrhea in children living in Milan, Italy , 2013, Infection.

[2]  S. Esposito,et al.  Implications of maternal vitamin D deficiency for the fetus, the neonate and the young infant , 2013, European Journal of Nutrition.

[3]  S. Bandinelli,et al.  Genetic variants and associations of 25-hydroxyvitamin D concentrations with major clinical outcomes. , 2012, JAMA.

[4]  M. Wessels,et al.  Vitamin D and the Human Antimicrobial Peptide LL-37 Enhance Group A Streptococcus Resistance to Killing by Human Cells , 2012, mBio.

[5]  C. Camargo,et al.  Randomized Trial of Vitamin D Supplementation and Risk of Acute Respiratory Infection in Mongolia , 2012, Pediatrics.

[6]  L. Deftos,et al.  PTH/PTHrP and Vitamin D Control Antimicrobial Peptide Expression and Susceptibility to Bacterial Skin Infection , 2012, Science Translational Medicine.

[7]  S. Esposito,et al.  Prevention of acute otitis media using currently available vaccines. , 2012, Future microbiology.

[8]  C. Gordon,et al.  Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. , 2012, The Journal of clinical endocrinology and metabolism.

[9]  Carsten Carlberg,et al.  Current status of vitamin D signaling and its therapeutic applications. , 2012, Current topics in medicinal chemistry.

[10]  D. Lawlor,et al.  Risk factors for variation in 25-hydroxyvitamin D₃ and D₂ concentrations and vitamin D deficiency in children. , 2012, The Journal of clinical endocrinology and metabolism.

[11]  A. Boner,et al.  Asthma, allergy and respiratory infections: the vitamin D hypothesis , 2012, Allergy.

[12]  E. Disu,et al.  Relationship between vitamin D levels and outcome of pneumonia in children. , 2011, West African journal of medicine.

[13]  J. Thomsen,et al.  A systematic review of the effect of tympanostomy tubes in children with recurrent acute otitis media. , 2011, International journal of pediatric otorhinolaryngology.

[14]  S. Esposito,et al.  Antibiotic treatment of acute otitis media in pediatrics. , 2011, Future microbiology.

[15]  T. Fuchigami,et al.  Serum vitamin D concentrations and associated severity of acute lower respiratory tract infections in Japanese hospitalized children , 2011, Pediatrics international : official journal of the Japan Pediatric Society.

[16]  J. Manson,et al.  The 2011 Dietary Reference Intakes for Calcium and Vitamin D: what dietetics practitioners need to know. , 2011, Journal of the American Dietetic Association.

[17]  M. South,et al.  Adverse events associated with the use of complementary and alternative medicine in children , 2010, Archives of Disease in Childhood.

[18]  A. Speciale,et al.  Acute otitis media: From diagnosis to prevention. Summary of the Italian guideline. , 2010, International journal of pediatric otorhinolaryngology.

[19]  G. Grevers Challenges in reducing the burden of otitis media disease: an ENT perspective on improving management and prospects for prevention. , 2010, International journal of pediatric otorhinolaryngology.

[20]  M. Urashima,et al.  Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. , 2010, The American journal of clinical nutrition.

[21]  R. Black,et al.  Vitamin D status and acute lower respiratory infection in early childhood in Sylhet, Bangladesh , 2010, Acta paediatrica.

[22]  S. Pelton,et al.  Recent Advances in Otitis Media , 2009, The Pediatric infectious disease journal.

[23]  S. Meropol Valuing Reduced Antibiotic Use for Pediatric Acute Otitis Media , 2008, Pediatrics.

[24]  J. Adams,et al.  Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity , 2008, Nature Clinical Practice Endocrinology &Metabolism.

[25]  W. Willett,et al.  The urgent need to recommend an intake of vitamin D that is effective. , 2007, The American journal of clinical nutrition.

[26]  P. Morris,et al.  Antibiotics for the prevention of acute and chronic suppurative otitis media in children. , 2006, The Cochrane database of systematic reviews.

[27]  R. Dagan,et al.  Acute otitis media caused by Streptococcus pyogenes in children. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[28]  Betsy Blazek-O'Neill Complementary and alternative medicine in allergy, otitis media, and asthma , 2005, Current allergy and asthma reports.

[29]  I. Dhooge Risk factors for the development of otitis media , 2003, Current allergy and asthma reports.

[30]  A. Gabr,et al.  Vitamin D administration to tuberculous children and its value. , 1998, Bollettino chimico farmaceutico.

[31]  H. Rockette,et al.  Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. , 1997, Pediatrics.

[32]  B. Alexander,et al.  Variability and reproducibility of circulating vitamin D in a nationwide U.S. population. , 2013, The Journal of clinical endocrinology and metabolism.

[33]  Wenyaw Chan,et al.  Statistical Methods in Medical Research , 2013, Model. Assist. Stat. Appl..

[34]  Clinical practice guidelines for the diagnosis and management of acute otitis media (AOM) in children in Japan. , 2012, Auris, nasus, larynx.

[35]  J. J. Grote,et al.  Recent advances in otitis media. 8. Treatment. , 2005, The Annals of otology, rhinology & laryngology. Supplement.

[36]  L. Vernon-Feagans,et al.  Recent advances in otitis media. 7. Diagnosis and screening. , 2005, The Annals of otology, rhinology & laryngology. Supplement.

[37]  D. Purdie Statistical Methods in Medical Research, 4th edn , 2003 .

[38]  P. Morris,et al.  Antibiotics for persistent nasal discharge (rhinosinusitis) in children. , 2002, The Cochrane database of systematic reviews.