South Valley Pediatrics

Xylitol

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.

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. Parker-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.