Conclusions Topical otic treatment with ciprofloxacin/dexamethasone otic suspension is superior to treatment withoral amoxicillin/clavulanic acid suspension, and it results inmore clinical cures and earlier cessation of otorrhea with feweradverse effects in children with acute otitis media with otor-rhea through tympanostomy tubes.

Commentary Several important caveats should be borne inmind when judging the validity of this study. Infants and youngchildren usually developed otorrhea after an upper respiratoryinfection.1 Cultures of their discharges consistently yield theusual pathogens of acute otitis media (Streptococcus pneumoniae,Haemophilus influenzae, Moraxella catarrhalis, and Streptococcuspyogenes). By contrast, older children are more likely to have earinfections in the summer swimming season. Cultures from theirear canals more often grow biofilm-producing organisms(Pseudomonas aeruginosa or Staphylococcus aureus), which aremuch less sensitive to the common oral antibiotics. Dohar et aldescribe a patient population that is quite different from the illinfants with new onset ear drainage seen by pediatricians. Morethan half of their subjects were older than 22 months of age, andsome had been treated as recently as 4 days prior with antibiotics.The organisms the authors recovered from culture do not reflectthe usual pathogens of acute otitis media, with only 15 of 154cultures growing S pneumoniae. Nearly all the US studies ofeardrops in the last decade have been funded and/or executed bypharmaceutical companies who profit greatly when we prescribeototopical drops. We must carefully review the patient popula-tions chosen and organisms cultured in these studies to knowwhether it is time to stop using oral antibiotics, especial in illinfants with perforated otitis or otorrhea through a tube.2

Glenn Isaacson, MDTemple University Children’s Medical Center

Philadelphia, PA

REFERENCES1. Mandel EM, Casselbrant ML, Kurs-Lasky M. Acute otorrhea: bacteriology of acommon complication of tympanostomy tubes. Ann Otol Rhinol Laryngol1994;103:713-8.2. Isaacson G. Why don’t those eardrops work for my patient? Pediatrics2006;118:1252-3.

Structured educational programs can improvethe treatment of atopic dermatitis and qualityof life of caregiversStaab D, Diepgen TL, Fartasch M, Kupfer J, Lob-Corzilius T,Ring J, et al. Age related, structured educational programmesfor the management of atopic dermatitis in children andadolescents: multicentre, randomised controlled trial. BMJ2006;332:933-8.

Question Among children and adolescents with moderateto severe atopic dermatitis, do structured educational pro-grams improve the management of this condition?

Design Multicenter, randomized controlled trial.

Setting Seven hospitals in Germany.

Participants Parents of children with atopic dermatitis3 months to 7 years of age (n � 274) and 8 to 12 years of age(n � 102), adolescents with atopic dermatitis 13 to 18 yearsof age (n � 70), and controls (n � 244, n � 83, and n � 50,respectively).

Intervention Group sessions of standardized interventionprograms for atopic dermatitis once weekly for 6 weeks or noeducation (control group).

Outcomes Severity of eczema (scoring of atopic dermatitisscale), subjective severity (standardized questionnaires), andquality of life for parents of affected children �13 years of agebut �12 months of age.

Main Results Significant improvements in severity of ec-zema and subjective severity were seen in all interventiongroups compared with control groups. Parents of affectedchildren �7 years of age experienced significantly betterimprovement in all 5 quality-of-life subscales, whereasparents of affected children 8 to 12 years of age experiencedsignificantly better improvement in 3 of 5 quality-of-lifesubscales.

Conclusions Age-related educational programs for the con-trol of atopic dermatitis in children and adolescents are ef-fective in the long-term management of the disease.

Commentary Atopic dermatis, as with other allergic dis-eases such as asthma, is a chronic illness punctuated byperiods of stability and exacerbations. Optimal treatment ismultifactorial and includes avoidance of triggers, use of top-ical moisturizers and anti-inflammatory agents, and adminis-tration of systemic anti-itch medications. This study evalu-ated the use of structured educational interventions for bothpatients and caregivers of patients with atopic dermatitis as acomplement to conventional medical therapies. Results fromthis study indicate significantly improved atopic dermatitissymptoms and improved quality of life among caregivers forthese patients. Although this study did include a controlgroup of patients who did not receive any educational pro-grams, the authors were unable to determine which aspects ofthe educational programs were most important for improvingatopic dermatitis outcomes. It is clear from this study (andsimilar studies in other age groups and other diseases) thatpatient-centered education improves disease management,and it should be included in the comprehensive manage-ment of atopic dermatitis. However, given the paucity oftime allotted for patient visits, this facet of care may bydifficult to implement.

Andrew Singer, MDUniversity of Michigan

Ann Arbor, MI

116 The Journal of Pediatrics • January 2007