Ceftazidime in the treatment of chronic suppurative otitis media in children
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Ceftazidime effectively treated Pseudomonas aeruginosa in children with otitis media, though some strains developed resistance. Clinical improvement was observed in most patients, highlighting ceftazidime
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Recurrent and chronic otitis media in children can be complicated by Pseudomonas aeruginosa infections.
- Previous antibiotic treatments often fail, necessitating alternative therapeutic strategies.
- Pseudomonas aeruginosa poses a significant challenge due to its potential for antibiotic resistance.
Purpose of the Study:
- To evaluate the efficacy and safety of ceftazidime in treating otitis media caused by Pseudomonas aeruginosa in pediatric patients.
- To assess the development of antibiotic resistance during ceftazidime treatment.
- To correlate clinical outcomes with microbiological eradication and serum drug levels.
Main Methods:
- A cohort of 17 children (5 months to 3 years) with otitis media due to Pseudomonas aeruginosa received ceftazidime.
- Initial susceptibility testing confirmed sensitivity to ceftazidime; MIC values for other antibiotics were also determined.
- Clinical and microbiological assessments were performed during and after treatment, with follow-up evaluations.
Main Results:
- Ceftazidime demonstrated initial efficacy, with Pseudomonas aeruginosa eradication in 11 patients during treatment.
- Four patients developed intermediate resistance to ceftazidime post-treatment.
- Clinical cure or improvement was achieved in 11 patients, with partial improvement in 3 others.
- Serum ceftazidime levels at 1 and 12 hours post-injection were measured.
Conclusions:
- Ceftazidime is a viable treatment option for pediatric otitis media caused by Pseudomonas aeruginosa, particularly when other antibiotics have failed.
- Monitoring for the emergence of resistance is crucial during ceftazidime therapy.
- Clinical improvement can occur even without complete microbiological eradication.
Abstract:
Seventeen children aged 5 months to 3 years with recurrent or chronic otitis media complicated by Pseudomonas aeruginosa were treated with ceftazidime. All patients had been previously treated with several antibiotics. All strains of Pseudomonas were initially sensitive to ceftazidime. In four of the six cases which failed bacteriologically, the Pseudomonas was found to be of intermediate sensitivity after treatment. In 11 patients the Pseudomonas was eradicated during treatment but reappeared in 4 during the follow-up period. All 11 patients were clinically cured or improved. Three of the six children whose Pseudomonas was not eliminated from aural discharge showed some clinical improvement whereas the remaining three showed no clinical response to treatment. The range of MIC values of ceftazidime, gentamicin and carbenicillin for the Pseudomonas isolated were respectively 0.5 to 4.0, 0.25 to 2.0 and 4.0 to 125 mg/l. The mean ceftazidime serum level at 1 h after the first injection of 50 mg/kg was 74.12 (S.D. 12.84) mg/l and at 12 h post injection 1.93 (S.D. 4.14) mg/l.