Middle ear infection or otitis media is the most common childhood bacterial infection and the leading cause of conductive hearing loss – which can occur during critical stages of children’s speech and language development. Now, a new animal study suggests repurposing an existing drug – vinpocetine, that has long been used to treat stroke and other neurological disorders – may provide a much needed, nonantibiotic, treatment.
The drug – which acts by limiting overproduction of mucus as opposed to targeting the bacteria causing the ear infection – may also address the urgent need for nonantibiotic treatments that reduce inflammation without side effects.
Vinpocetine is a synthetic ethyl ester of apovincamine, an alkaloid obtained from the leaves of the lesser periwinkle (Vinca minor) and discovered in the late 1960s. Also known by the trade name Cavington, vinpocetine is used as an anti-stoke drug in most countries and a dietary supplement worldwide.
In the new study, published in the Journal of Immunology, researchers at Georgia State University and the University of Rochester showed that vinpocetine could be an effective treatment for middle ear infection.
They describe how the drug suppressed mucus overproduction, improved bacterial clearance and reduced hearing loss in mice caused by Streptococcus pneumonia bacteria, the most common cause of middle ear infection.
The team suggests the drug could be repurposed as a new, nonantibiotic treatment for otitis media, possibly through topical delivery (that is applied to the affected area as opposed to injection or tablet form).
Senior author Dr. Jian-Dong Li, director of the Institute for Biomedical Sciences at Georgia State, suggests:
“Our proposed studies may lead to developing novel, nonantibiotic therapeutic strategies to control immunopathology, reduce mucus overproduction, improve hearing loss and enhance host defense for otitis media.”
There is an urgent need for nonantibiotic drugs to suppress overactive inflammation without significant side effects – especially as inappropriate antibiotic use has led to increased resistance. And vaccines against S. pneumonia have limited effect in otitis media, says Dr. Li.
However, because we don’t know much about how S. pneumonia causes infection in the middle ear, there are no nonantibiotic treatments available.
We do know that mucin, the main component of mucus, plays an important role clearing away unwanted bacteria. But what can happen is that the body produces too much mucus, resulting in conductive hearing loss and less effective clearance of bacteria.
In their study, the researchers found that in cultured middle ear epithelial cells and in the middle ear of mice with middle ear infection, vinpocetine inhibited S. pneumoniae‘s upregulation of a gene that produces mucin.
Repurposing an existing drug has many advantages over proposing a new, experimental drug. It saves time and cost, and should also reduce safety risks – the authors note there have been no reports of significant adverse effects or toxicity of vinpocetine used in therapeutic doses in adults and children.
In the US, pediatric ear infections cost the health care system billions of dollars a year.
A 2014 study by researchers at Harvard University and the University of California Los Angeles, found that children with ear infections had an average of two additional outpatient visits, 0.2 emergency room visits and 1.6 prescriptions filled, compared with those without ear infections.
In that study, the team estimated that ear infections were associated with an increased cost of $314 per child per year for outpatient care, and an average of $17 in medication costs. Across the US, this added up to $2.88 billion of direct cost of health care for children’s ear infections every year. This figure excludes costs associated with work and school days missed, and cost of travel to and from hospitals and clinics.