Xylitol chewing gum reduced the occurrence of acute otitis media in children in day care

Objective To evaluate the effectiveness of xylitol in preventing acute otitis media. Design A randomised, double-blind, placebocontrolled trial with 2-month followup. Setting 11 day care nurseries in Oulu, Finland. Patients 306 children (mean age 5 y, 51% boys) in day care completed the study (91% of those originally included). Most children had previous problems with acute otitis media. Children with dental caries were advised not to participate. Intervention 167 children who completed the study were allocated to xylitol chewing gum, 8.4 g/d, and 169 to sucrose chewing gum. Each child was instructed to chew 2 pieces of gum 5 times a day after meals or snacks for 2 months. The chewing was to last until there was no taste left or for ≥ 5 minutes. Main outcome measures Occurrence of acute otitis media, use of antimicrobial treatment, rate of nasopharyngeal carriage of Streptococcus pneumoniae, and adverse effects. Main results During the 2-month intervention period, 19 children (12%) who received xylitol had at least 1 occurrence of acute otitis media compared with 31 children (21%) in the sucrose group (P = 0.04). {This absolute risk reduction (ARR) of 9% means that 12 children would need to be treated (NNT) with xylitol for 2 months (compared with sucrose) to prevent 1 additional child from having an occurrence of acute otitis media, 95% CI 6 to 237; the relative risk reduction (RRR) was 42%, CI 2% to 66%.}* At least 1 episode of antimicrobial drug prescription occurred in 29 children (19%) in the xylitol group compared with 43 children (29%) in the sucrose group (P = 0.03) {ARR 10%; NNT 10, CI 5 to 113; RRR 36%, CI 4% to 58%}*. Pneumococcal carriage rates varied from 17% to 28% during the study with no statistically significant differences between the treatment groups. 2 children in the xylitol group had diarrhoea and discontinued use of the gum, but the number of episodes and the mean duration of diarrhoea were similar in the 2 groups. Conclusion Xylitol chewing gum reduced the occurrence of acute otitis media and the number of episodes of antimicrobial drug prescription for this condition in children in day care.