ID-Ear References ================= Chamberlain JM Boenning DA Waisman Y Ochsenschlager DW Klein BL Single-dose ceftriaxone versus 10 days of cefaclor for otitis media. In: Clin Pediatr (Phila) (1994 Nov) 33(11):642-6 We conducted a controlled clinical trial to determine the efficacy of single-dose intramuscular ceftriaxone for the treatment of acute otitis media. Fifty-four children aged 18 months to 6 years with clinical and tympanometric evidence of otitis media were randomized to receive either 50 mg/kg ceftriaxone or 10 days of oral cefaclor 40 mg/kg/day. Resolution of symptoms and clinical and tympanometric appearance of the tympanic membrane at follow-up visits were used to determine outcome. Thirty-one children received ceftriaxone and 23 received oral cefaclor. There were no treatment failures. There were no significant differences between groups in persistence of effusion or recurrence of acute otitis media. We conclude that a single intramuscular dose of ceftriaxone compares favorably with 10 days of oral cefaclor for the treatment of acute otitis media. Fleisher GR Rosenberg N Vinci R Steinberg J Powell K Christy C Boenning DA Overturf G Jaffe D Platt R Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia [see comments] In: J Pediatr (1994 Apr) 124(4):504-12 Because studies of the treatment of children with occult bacteremia have yielded conflicting results, we compared ceftriaxone with amoxicillin for therapy. Inclusion criteria were age 3 to 36 months, temperature > or = 39 degrees C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for six doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were evaluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b, 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatment, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two from the spinal fluid (two H. influenzae type b), compared with none given ceftriaxone. Probable or definite infections occurred in three children treated with ceftriaxone and six given amoxicillin (adjusted odds ratio 0.43, 95% confidence interval 0.08 to 1.82, p = 0.31). The five children with definite bacterial infections (three meningitis, one pneumonia, one sepsis) received amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p = 0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.94, p = 0.04). Although the difference in total infections was not significant, ceftriaxone eradicated bacteremia, prevented significantly more definite focal bacterial complications, and was associated with less persistent fever. Puczynski MS Stankiewicz JA O'Keefe JP Single dose amoxicillin treatment of acute otitis media. In: Laryngoscope (1987 Jan) 97(1):16-8 A double blind study comparing a single dose of amoxicillin versus a 10-day course of amoxicillin in the treatment of acute otitis media (AOM) was undertaken. All children diagnosed with AOM in a pediatric clinic were requested to participate. After tympanocentesis was performed, patients were randomly assigned to receive either amoxicillin (100 mg/kg) followed by placebo every 8 hours for 10 days or placebo followed by amoxicillin (40 mg/kg/D) for 10 days. Patients returned to clinic on days 3 and 10 post-treatment. Seventeen patients were enrolled: 7 received single dose therapy and 10 received 10 days of therapy. There were no failures in the control group and 3 failures in the single dose group (day 5, day 6, and 11) (p = 0.05). Middle ear isolates included: S. pneumoniae 7, H. influenzae 4, B. catarrhalis 1, and no pathogen in 5. Due to the significant number of failures in the treatment group, the study was prematurely terminated. Green SM Rothrock SG Single-dose intramuscular ceftriaxone for acute otitis media in children [see comments] In: Pediatrics (1993 Jan) 91(1):23-30 This study evaluated the efficacy of a single dose of intramuscular ceftriaxone for acute otitis media in children, using amoxicillin as a control. (There is currently no established single-dose treatment for this condition.) In a prospective, randomized, double-blind, clinical trial, 233 children, aged 5 months to 5 years, with uncomplicated acute otitis media were randomly assigned to receive either a single intramuscular injection of ceftriaxone (50 mg/kg) plus placebo oral suspension for 10 days, or a placebo injection plus amoxicillin oral suspension (40 mg/kg per day divided three times per day) for 10 days in a double-blind fashion. Demographic and clinical characteristics were similar in both groups. Treatment was successful in 107 of 117 given amoxicillin (91%, 95% confidence interval 86% to 97%) and 105 of 116 given ceftriaxone (91%, 95% confidence interval 85% to 96%). Rates of improvement, failure, relapse, and reinfection were similar in both groups, as were the otoscopic and tympanometric evaluations at the 14- and 60-day follow-up visits. It is concluded that a single intramuscular injection of ceftriaxone (50 mg/kg) is as effective as 10 days of oral amoxicillin for the treatment of uncomplicated acute otitis media in children. Reichler MR Rakovsky J Sobotova A Slacikova M Hlavacova B Hill B Krajcikova L Tarina P Facklam RR Breiman RF Multiple antimicrobial resistance of pneumococci in children with otitis media, bacteremia, and meningitis in Slovakia. In: J Infect Dis (1995 Jun) 171(6):1491-6 Penicillin-resistant pneumococci have been isolated from middle ear fluid, blood, cerebrospinal fluid, and nasopharyngeal secretions of several hundred children in Slovakia since 1985; 116 of these isolates were serotyped and tested for susceptibility to antimicrobial drugs at the Centers for Disease Control and Prevention. To define the prevalence of drug-resistant pneumococci and identify risk factors for infection, laboratory and medical records were reviewed. Nearly all (96%) of the resistant strains tested were serotype 14. Of these, all were resistant to penicillin (MIC, 4-16 micrograms/mL); most were resistant to cefaclor, erythromycin, tetracycline, and chloramphenicol; and many had decreased susceptibility to trimethoprim-sulfamethoxazole and ceftriaxone. Frequent antibiotic use, prior hospitalization, and length of hospital stay (P < .001 for all 3) were associated with infection with resistant strains. These findings suggest the need for routine screening of pneumococcal isolates for penicillin resistance and highlight the importance of controlling globally the spread of resistant pneumococci. Barnett ED Klein JO The problem of resistant bacteria for the management of acute otitis media. In: Pediatr Clin North Am (1995 Jun) 42(3):509-17 The emergence of pneumococci resistant to penicillin has prompted an examination of the role of resistant organisms in the response to treatment for AOM. At this time, antibiotic-resistant organisms play a small role in the number of episodes of AOM that do not respond to initial therapy. Amoxicillin remains the drug of choice for treatment of AOM. For children who do not respond, assessment of clinical status is important. Children who are well-appearing may respond to a beta-lactamase stable oral agent. Children who are ill may require tympanostomy and presumptive therapy for infection due to resistant organisms. Shapiro AM Bluestone CD Otitis media reassessed. Up-to-date answers to some basic questions. In: Postgrad Med (1995 May) 97(5):73-6, 79-82 For children with acute otitis media, appropriate antibiotic therapy provides a modest improvement over the high rate of spontaneous recovery and, more importantly, has greatly reduced the incidence of serious complications. Prophylaxis with antibiotics is beneficial for patients with recurrent episodes. Otitis media with effusion also has a high rate of spontaneous resolution, and many physicians have adopted a "wait and see" approach to this problem. Modification of risk factors may be helpful. Antibiotic therapy is recommended for infants who have otitis media with effusion (since they cannot relate symptoms); patients with a coexisting purulent infection of the upper respiratory tract; patients who have significant hearing loss, vertigo, or structural changes in the tympanic membrane; and patients who have had effusion for more than 2 to 3 months. Referral to an otolaryngologist should be considered if medical therapy for recurrent acute otitis media or chronic otitis media with effusion has failed or been poorly tolerated, or if complications are present. McCracken GH Jr Emergence of resistant Streptococcus pneumoniae: a problem in pediatrics. In: Pediatr Infect Dis J (1995 May) 14(5):424-8 Penicillin resistance among strains of Streptococcus pneumoniae has emerged as an important worldwide problem. Beta-lactam-resistant pneumococci also can be resistant to erythromycin, trimethoprim/sulfamethoxazole and tetracycline and are uniformly susceptible to vancomycin and imipenem. Crowded conditions (e.g. daycare centers, hospitals, military barracks and prisons) and prior beta-lactam antibiotic therapy are the principal predisposing factors to colonization and disease. To date the two conditions caused by penicillin- and cephalosporin-resistant pneumococci that have been especially difficult to treat are acute otitis media and meningitis. Concentrations of beta-lactams in cerebrospinal fluid and middle ear fluid are usually inadequate to achieve prompt eradication of some intermediately resistant and most highly resistant pneumococcal strains. Use of unconventional therapeutic agents such as ceftriaxone or clindamycin for acute otitis media and vancomycin or rifampin for meningitis may be necessary. Control of this global problem will require innovative methods to reduce the selective pressure that results from widespread antibiotic use and to develop effective pneumococcal vaccines that are immunogenic in young infants.