Children with low levels of vitamin D and recurrent ear infections had a reduced risk for acute otitis media with vitamin D supplementation, researchers reported here.

Compared with children randomized to placebo, patients with recurrent acute otitis media (AOM) who received 1,000 IU daily had significantly lower risk of experiencing one or more episodes of AOM (26 incidents versus 38 incidents, P=0.03), and the risk of uncomplicated acute otitis media was markedly smaller in the vitamin D group (P<0.001), according to Susanna Esposito, MD, of the Universita degli Studi di Milano in Italy, and colleagues.

“In clinical practice, this means that in children with recurrent otitis media, we can check their levels of vitamin D and for those with low serum levels of it consider supplement use as a treatment for their condition,” she said during a presentation at the Interscience Conference on Anti-Microbial Agents and Chemotherapy.

Particularly among younger children, ear infections are a common hazard. Research published earlier in September 2013 concluded that all children younger than 2 years should receive antibiotic treatment for acute otitis media, while recommendations from the American Academy of Pediatrics in February 2013 told pediatricians to follow stricter diagnostic criteria and to observe patients who have uncomplicated disease.

“What we learn about nutrition and how that impacts infectious disease” may have a broader impact on recommendations for nutrition and other elements of childcare going forward, noted Craig Rubens, MD, PhD, of Seattle Children’s Hospital Research Institute in Washington.

The authors conducted a randomized study of 116 children with recurrent otitis media who were treated with daily doses of oral 1,000 IU of vitamin D or with placebo over 4 months and whose episodes of acute otitis media were monitored for 6 months.

Recurrent disease was defined as three or more episodes in the 6 months prior to the study or four or more episodes in the 12 months prior to the study. Participants had a mean age of 33.4 months in the placebo group and 34.3 months in the vitamin D group. Most were white (98.3% and 100%, respectively) and had been breast feeding for 3 or more months (72.4% and 84.1%). All had been vaccinated with the influenza vaccine, and the majority had received a heptavalent pneumococcal conjugate vaccine (82.8% for both groups). Mean vitamin D blood concentrations were 25.8 ng/mL and 26.5 ng/mL, respectively, which were both below the recommended level of 30 ng/mL, Esposito noted. The average number of episodes of acute otitis media over 12 months prior to the study was roughly five between groups (five versus 4.97), and roughly one-third of the cases were complicated by perforation (36.2% for both). At 6-month follow-up, blood vitamin D was significantly higher in those treated with supplements versus placebo (36.2 ng/mL versus 18.7 ng/mL, P<0.001). Additionally, there were significantly fewer children who had one or more episodes of acute otitis media in the group treated with supplement, particularly among those with uncomplicated disease (10 versus 29, P<0.001). There was no significant difference between groups for those whose disease was complicated by perforation. She added that treatment was well-tolerated and that the number of adverse events was not significantly different between groups (five events with placebo versus six with vitamin D, P=0.75). ###