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[A clinicobacteriologic study on clavulanic acid/amoxicillin in pediatric acute otitis media]
Abstract:
We carried out clinical and bacteriological studies on clavulanic acid/amoxicillin and amoxicillin in pediatric acute otitis media at 14 general practice settings. The results are summarized as follows. 1. The major isolated organisms from content of middle ear effusion were Streptococcus pneumoniae 31.8%, Haemophilus influenzae 35.8% and Moraxella subgenus Branhamella catarrhalis 1.5%. Similar results were observed for the major isolates organisms from content of nasopharynx Streptococcus pneumoniae 31.1%, Haemophilus influenzae 33.9% and Moraxella subgenus Branhamella catarrhalis 19.2%. 2. 42.2% of S. pneumoniae isolated from middle ear effusion were drug resistant S. pneumoniae (PISP, PRSP) and they were increasing year by year. 3. 46.7% of S. pneumoniae isolated from nasopharyngeal swab were drug resistant S. pneumoniae (PISP, PRSP) and they were increasing year by year. The incidence of drug resistant S. pneumoniae isolated from all cases and organisms were 26.3% and 14.5%, respectively. 4. On MIC90, antimicrobial activity of CVA/AMPC against Streptococcus pneumoniae, Haemophilus influenzae and Moraxella subgenus Branhamella catarrhalis was superior to SBTPC. 5. In the evaluation of clinical efficacy, bacteriological efficacy and utility, CVA/AMPC-treated group was significantly superior to AMPC-treated group. 6. Adverse reactions were observed in 22% of CVA/AMPC-treated group, involving diarrhea and loose stool.
Insights
Clavulanic acid/amoxicillin (CVA/AMPC) demonstrated superior efficacy over amoxicillin alone in treating pediatric acute otitis media, despite some adverse effects. This highlights CVA/AMPC as a key treatment option against resistant bacteria.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Pediatric acute otitis media (AOM) is frequently caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- Increasing prevalence of drug-resistant Streptococcus pneumoniae (PRSP) in middle ear effusion and nasopharyngeal samples poses a therapeutic challenge.
- Amoxicillin and clavulanic acid/amoxicillin (CVA/AMPC) are commonly used antibiotics for AOM.
Purpose of the Study:
- To compare the clinical and bacteriological efficacy of CVA/AMPC versus amoxicillin in pediatric AOM.
- To identify the prevalence of drug-resistant S. pneumoniae in pediatric AOM cases.
- To evaluate the in vitro antimicrobial activity of CVA/AMPC.
Main Methods:
- Clinical and bacteriological study conducted in 14 general practice settings.
- Isolation and identification of bacteria from middle ear effusion and nasopharyngeal swabs.
- Antimicrobial susceptibility testing, including MIC90 determination.
- Clinical efficacy and adverse reaction assessment.
Main Results:
- Streptococcus pneumoniae (31.8%), Haemophilus influenzae (35.8%), and Moraxella catarrhalis (19.2%) were the predominant pathogens.
- High rates of drug-resistant S. pneumoniae (PRSP) were observed in both middle ear effusion (42.2%) and nasopharyngeal samples (46.7%).
- CVA/AMPC exhibited superior antimicrobial activity and clinical efficacy compared to amoxicillin, with a 22% incidence of adverse reactions like diarrhea.
Conclusions:
- CVA/AMPC is more effective than amoxicillin for treating pediatric AOM, particularly in the context of rising antibiotic resistance.
- The study underscores the importance of monitoring antibiotic resistance patterns in common pediatric infections.
- CVA/AMPC offers a valuable therapeutic option, though potential side effects should be considered.