Fw: [crataegus] XYLITOL PROPHYLAXIS IN OTITIS MEDIA AND IN BACTERIAL SINUSITIS

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[crataegus] XYLITOL PROPHYLAXIS IN OTITIS MEDIA AND IN BACTERIAL

SINUSITIS

This is a great article on a very understandible level. Could please

someone forward to the other CF lists (parents, CysticL etc)?

XYLITOL PROPHYLAXIS IN OTITIS MEDIA AND IN BACTERIAL SINUSITIS

We are interested in using xylitol, as an alternative to conventional

antibiotics for the prevention of ear infections (otitis media) in

children who are prone to them. The use of conventional antibiotics

for this purpose carries with it the risk of the evolution of

resistant bacteria that then may be difficult to control. Xylitol is

not a substitute for vaccines against Streptococcus pneumonia, the

leading cause of otitis media, nor can it be used to treat an active

case of otitis. We do, however, feel that it has a place in the

prevention of otitis media in selected children and perhaps in

prevention of bacterial sinusitis.

Research, done chiefly in Finland, provides evidence of xylitol being

effective in preventing otitis media in children 1,2. The Wall Street

Journal recently presented a nice overview of the subject3. Depending

upon the form in which xylitol is administered the frequency of bouts

of otitis among at risk children was reduced 20-40% in those on

xylitol when compared to controls. We am unaware of reports on the

role of xylitol in sinusitis, but since the organisms that cause

otitis in children are also the culprits in sinusitis one would

expect it to be effective.

Xylitol is a sugar that has been used as a substitute for ordinary

sugar (sucrose) because of its preventive effects on dental caries as

it inhibits the growth of the bacteria Streptococcus mutans that

causes tooth decay.

Xylitol inhibits the growth of Streptococcus pneumoniae, the organism

that is the leading cause of otitis media as well. The sugar has also

been shown to have anti-adhesive effects on Streptococcus pneumoniae

and on Hemophilus influenza. 4

The effects of xylitol are thought to be topical, that is it acts

directly on bacteria in the mouth, throat and nose. The longer the

medication is in these sites the better. Preventive treatment has, as

a consequence, entailed the use of xylitol chewing gum or xylitol

syrup given frequently in small doses. Other means of administration

seem feasible as well. The type and dose of xylitol recommended for

your child will be discussed with you. Options include:

1. Xylitol chewing gum, for children able to chew gum and not swallow

it promptly, is administered throughout the day so that the child

receives about 10 Gm/day. Thus fifteen (15) pieces of gum are

required daily. We recommend chewing three (3) pieces at a time until

the gum is no longer sweet. Gum is refreshed five (5) times a day

attempting to space it out evenly. Gum after each of three meals, in

mid-afternoon and before bedtime is suggested. If your child needs a

note for school to facilitate this treatment we will provide one. Gum

costs about $0.10 a piece; this treatment costs about $1.50/day.

2. Xylitol mints are an option for the younger child who may not be

able to chew gum without promptly swallowing it, but who can chew a

pleasant tasting mint several times a day. About fifteen (15) mints

must be taken each day at times noted above. Mints cost about $0.12

each; this treatment costs about $1.80/day.

3. Xylitol syrup is being developed in several flavors but must be

administered in small frequent doses to be effective. This product is

not yet available.

4. Xylitol granules are available. A syrup can be made from this

produce. We think that an infant's wet pacifier can be dipped in

xylitol granules periodically so that the daily dose of the

medication can be administered in this fashion.

5. A xylitol nasal spray (Xlear) is also available. A possible role in

prevention of bacterial rhinosinusitis remains to be shown.

There are few adverse effects of xylitol. It can cause diarrhea when

taken in large amounts, usually four (4) times the dose given your

child. Abdominal discomfort is the only other adverse effect seen in

studies to date.

Candidates for xylitol treatment:

[1] Children with antibiotic resistant otitis media who have, after a

series of different medications, finally cleared their ear infection.

A 3 month period of prophylaxis might prevent recurrence.

[2] Children who, by history, predictably develop otitis media after a

" cold " or other viral illness. Xylitol would be started at the first

sign of that predisposing illness.

[3] Children who have frequent bouts of otitis media. Prophylaxis

would be indicated during months when predisposing viral infections

are common.

[4] Children who tend to develop bacterial sinusitis after viral URI

or allergic rhinosinusitis would be treated with xylitol nasal spray

during these episodes in order to prevent secondary bacterial

sinusitis.

Xylitol is not a prescription type medication and insurance carriers

do not cover its cost yet.

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1. Uhari M, Kontiokari T and Niemela M. A novel use of xylitol sugar

in preventing otitis media. Pediatrics 1998;102:879.

2. Uhari M, Kontiokari T, Koskela M and Niemela M. Xylitol chewing

gum in preventing otitis media: double blind randomised trial. Brit

Med J 1996;313:1180.

3. -Pope T. Wall Street Journal Health Journal Friday, June 30,

2000.

4. Kontiokari T, Uhari M, Koskela M. Antiadhesive effects of xylitol

on otopathogenic bacteria. J Antimicrob Chemmother. 1998;41:563

We are glad to provide copies of these publications or abstracts of

them.

WARNING: This is an open discussion of medical and alternative ideas and

possibilities. No posting on this list is a promotion of medical treatment. In

the care of cystic fibrosis always be honest with your physician. This is not a

medical group. This is a group of people exploring possibilities of care in a

free and open discussion. There are no doctors advising care on this list.

Medical professionals should be kept up to date with any changes or considered

changes in personal treatment.

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