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Clinical Outcomes Associated with Amoxicillin Treatment for Acute Otitis Media in Children
Holly M Frost1,2,3, Amy Keith2, Dana R Fletcher4
1Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO, USA.
Background:
Acute otitis media (AOM) is the most common reason children are prescribed antibiotics. Bacteria that produce beta-lactamase are an increasingly frequent cause of AOM and may be resistant to amoxicillin, the currently recommended treatment for AOM. We aimed to evaluate the clinical outcomes of children treated with amoxicillin for AOM and assessed whether outcomes vary by infecting pathogen or beta-lactamase production.
Methods:
205 children 6-35 months old diagnosed with AOM and prescribed amoxicillin were included. Bacterial culture and qualitative multiplex real-time polymerase chain reaction were performed on nasopharyngeal swabs collected at enrollment. Parents completed surveys assessing symptoms, antibiotic adherence, and potential adverse events. The primary outcome was treatment failure with amoxicillin. Secondary outcomes included recurrence, symptom improvement, resolution, and adverse drug events (ADE).
Results:
8 children (5.4%) experienced treatment failure and 14 (6.8%) had recurrence. By day 5, 152 (74.1%) children had symptom improvement and 97 (47.3%) had resolution. Parents reported ADE for 56 (27.3%) children. Among 149 children who did not take any amoxicillin before enrollment, 98 (65.8%) had one or more beta-lactamase-producing bacteria. Common bacterial otopathogens were Moraxella catarrhalis (79, 53.0%), Streptococcus pneumoniae (51, 34.2%), Haemophilus influenzae (30, 20.1%), and Staphylococcus aureus (21, 14.1%). Treatment failure did not differ between children that did (5, 5.1%) and did not (3, 5.9%) have beta-lactamase-producing otopathogens (p = .05).
Conclusions:
Among children diagnosed with AOM treated with amoxicillin, treatment failure was uncommon and did not differ by pathogen or beta-lactamase production. These data support guidance recommending amoxicillin despite an increasing prevalence of beta-lactamase-producing bacteria.
Insights
Amoxicillin is effective for treating acute otitis media (AOM) in children, even with common beta-lactamase-producing bacteria. Treatment failure rates were low and did not vary based on pathogen or resistance.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Acute otitis media (AOM) is a leading cause of antibiotic prescriptions in children.
- Increasing prevalence of beta-lactamase-producing bacteria poses a challenge to amoxicillin treatment efficacy for AOM.
- This study evaluates clinical outcomes of amoxicillin treatment for AOM in relation to bacterial pathogens and beta-lactamase production.
Purpose of the Study:
- To assess the clinical outcomes of amoxicillin treatment in children diagnosed with AOM.
- To determine if treatment outcomes for AOM differ based on the infecting pathogen or the presence of beta-lactamase production.
Main Methods:
- A cohort of 205 children aged 6-35 months with AOM treated with amoxicillin was studied.
- Nasopharyngeal swabs were analyzed using bacterial culture and multiplex real-time polymerase chain reaction (PCR).
- Primary outcome was treatment failure; secondary outcomes included recurrence, symptom improvement, resolution, and adverse drug events (ADE).
Main Results:
- Treatment failure occurred in 5.4% of children, with recurrence in 6.8%.
- By day 5, 74.1% of children showed symptom improvement and 47.3% had symptom resolution.
- Treatment failure rates were similar whether or not beta-lactamase-producing otopathogens were present (5.1% vs. 5.9%, p=0.05).
Conclusions:
- Amoxicillin treatment for AOM in children resulted in uncommon treatment failure.
- Treatment outcomes did not significantly differ based on the infecting pathogen or beta-lactamase production.
- Findings support the continued recommendation of amoxicillin for AOM treatment despite rising beta-lactamase-producing bacteria.
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