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[Antibiotic management of acute otitis media. New recommendations]
1Service des Maladies infectieuses et tropicales (Pr J.L. Vildé), Hôpital Bichat-Claude Bernard, 48, rue Henri Huchard, F 75018 Paris.
Abstract:
FAILURES OF ANTIBIOTIC TREATMENT: The number of failures after treatment of acute middle ear infections with the 2 main antibiotics prescribed (amoxicillin and the combination amoxicillin-clavulanic acid) is on the rise. These failures appear to be related to increased resistance of the 2 principal pathogens, pneumococci and Hemophilus influenzae. A NEW FORMULATION: In order to reduce the rate of failure, it has been necessary to both increase the dose of penicillin to overcome the reduced susceptibility of pneumococci to penicillin and to prescribe a beta-lactam because of the frequent isolation of beta-lactamase producing Hemophilus influenzae. A new formulation has been developed where the amoxicillin-clavulanic acid dose is 14 to 1. This allows a daily dose of 80 mg/kg for amoxicillin and 6.4 mg/kg for clavulanic acid. In one open multicentric study including 51 pediatric patients aged 3 to 48 months with acute middle ear infections, it was demonstrated that this new formulation can be very effective in eradicating the causal agents of acute middle ear infections, including pneumococci and penicillin-resistant Hemophilus. RECOMMENDATIONS FOR GOOD EFFICACY: Amoxicillin must always be prescribed, either alone or in combination with clavulanic acid, at the dose of 45 to 50 mg/kg b.i.d. the amoxicillin-clavulanic acid combination should be preferred for children under 2 years due to the risk of beta-lactamase producing Hemophilus.
Insights
Treatment failures for acute middle ear infections are rising due to antibiotic resistance. A new amoxicillin-clavulanic acid formulation shows promise in eradicating resistant pathogens in pediatric patients.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Pharmacology
Background:
- Antibiotic treatment failures for acute middle ear infections (otitis media) are increasing.
- This rise is linked to growing resistance in key pathogens like pneumococci and *Hemophilus influenzae*.
- Standard antibiotic doses may be insufficient to overcome reduced susceptibility and beta-lactamase production.
Purpose of the Study:
- To evaluate a new formulation of amoxicillin-clavulanic acid for treating acute middle ear infections.
- To assess the efficacy of an increased amoxicillin dose and a beta-lactam in combating resistant bacteria.
- To determine if the new formulation can effectively eradicate common otitis media pathogens.
Main Methods:
- An open, multicenter study was conducted.
- The study included 51 pediatric patients aged 3 to 48 months with acute middle ear infections.
- A new amoxicillin-clavulanic acid formulation (14:1 ratio) was administered, allowing daily doses of 80 mg/kg for amoxicillin and 6.4 mg/kg for clavulanic acid.
Main Results:
- The new amoxicillin-clavulanic acid formulation demonstrated high effectiveness.
- It successfully eradicated key causal agents of acute middle ear infections.
- Eradication included penicillin-resistant *Hemophilus influenzae* and pneumococci.
Conclusions:
- The novel amoxicillin-clavulanic acid formulation is highly effective in treating acute middle ear infections in young children.
- This formulation aids in overcoming antibiotic resistance, including penicillin-resistant strains.
- Recommendations include using amoxicillin (alone or combined) at 45-50 mg/kg twice daily, preferring the combination for children under two.