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Phenoxymethylpenicillin and therapeutic failure in acute otitis media
Abstract:
The aim of the present investigation was to determine to what extent beta-lactamase producing Haemophilus influenzae (H.i.) and Branhamella catarrhalis (B.c.) were isolated in cases of failure of treatment of acute otitis media (AOM) with phenoxymethylpenicillin. Among children with suspected therapeutic failure referred to an ENT specialist altogether 11, 15% of those referred, fulfilled the criteria of AOM. Three of them were on erythromycin, 1 on ampicillin and 7 on phenoxymethylpenicillin. In 5 of the children treated with phenoxymethylpenicillin H.i. was isolated from middle ear exudate and/or the nasopharynx. All H.i. isolates were non-capsulated and beta-lactamase negative. One beta-lactamase producing B.c. was isolated from the nasopharynx in a patient with pure culture of H.i. in the ear exudate. The present investigation did not support the suggestion that beta-lactamase producing H.i. or B.c. are major causative agents in therapeutic failures of AOM treated with phenoxymethylpenicillin and did not produce any evidence supporting a change from the recommended ampicillin esters/amoxycillin in therapeutic failures.
Insights
Beta-lactamase producing bacteria were not major causes of treatment failure in acute otitis media (AOM) with phenoxymethylpenicillin. This study found no evidence to change current antibiotic recommendations for AOM treatment failures.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Treatment failures with phenoxymethylpenicillin raise concerns about bacterial resistance.
- Beta-lactamase producing bacteria like Haemophilus influenzae and Branhamella catarrhalis are potential causes of antibiotic resistance.
Purpose of the Study:
- To investigate the prevalence of beta-lactamase producing Haemophilus influenzae (H.i.) and Branhamella catarrhalis (B.c.) in treatment failures of AOM.
- To determine if these resistant strains are significant contributors to phenoxymethylpenicillin treatment failures in AOM.
- To provide evidence regarding the efficacy of current antibiotic recommendations for AOM.
Main Methods:
- Retrospective analysis of children with suspected AOM treatment failure.
- Microbiological culture of middle ear exudate and nasopharyngeal samples.
- Identification and susceptibility testing of isolated bacterial pathogens, including beta-lactamase production.
Main Results:
- 11.15% of referred children met AOM criteria.
- In children treated with phenoxymethylpenicillin, H.i. was isolated in 5 cases; all were beta-lactamase negative.
- One beta-lactamase producing B.c. was found in the nasopharynx of a patient with H.i. in the ear.
Conclusions:
- Beta-lactamase producing H.i. and B.c. are unlikely to be major causative agents in AOM treatment failures with phenoxymethylpenicillin.
- The study does not support changing current recommendations for ampicillin esters/amoxycillin in AOM treatment failures.
- Further research may be needed to fully understand AOM treatment failures and antibiotic resistance patterns.