Experimental and investigational drugs for the treatment of acute otitis media

Introduction: Acute otitis media (AOM) is a common disease, particularly in infants and young children. Almost all children experience at least one episode of AOM in the first 3 years of age, and approximately 50% experience recurrent episodes in the same period of time. Areas covered: Some new potentially effective preventive or therapeutic approaches to AOM have been identified and are not discussed even in the most updated guidelines. The main aim of this narrative review is to detail what has been recently suggested. Expert opinion: Several new measures have been suggested to reduce systemic antibiotic abuse in AOM therapy and prophylaxis. For therapy, the administration of preparations containing antibiotics, bacteriophages or peptides can allow trans-tympanic passage of effective anti-otopathogen measures and the use of vaccines or immunoglobulins can disrupt biofilm. For AOM prophylaxis, new vaccines and the use of probiotics by nasal spray are in development. However, further advances in the selection of children for whom antimicrobial therapy and/or prophylaxis measures are truly needed could be derived from studies that analyse the association between genetic characteristics of the host and development of AOM with specific characteristics of aetiology or tendency to recur.