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Erythromycin-sulfisoxazole for persistent acute otitis media due to ampicillin-resistant Haemophilus influenzae
Abstract:
In patients with acute otitis media who had failed to improve with ampicillin therapy, 35% of Haemophilus strains isolated from the middle ear were ampicillin-resistant. Twenty-nine children (24 of whom had failed to respond to ampicillin) were treated with 40 mg erythromycin ethylsuccinate per kg per day and 100 to 150 mg sulfisoxazole per kg per day. Middle ear exudate was cultured on chocolate and 5% sheep blood agar. Twenty-three of 29 Haemophilus isolates were nontypable, 10% (3 children) were type b, 2 were Haemophilus parainfluenzae and one was not typed. All strains were resistant to ampicillin by disc susceptibility testing, and 28 of 29 strains produced beta-lactamase. The minimal inhibitory concentration of ampicillin for 15 strains ranged from 3.12 to 100 micrograms/ml (median, 6.25 micrograms/ml). The erythromycin ethylsuccinate and acetyl sulfisoxazole combination was effective in treatment of acute otitis media secondary to ampicillin-resistant Haemophilus influenzae. After 10 days of erythromycin ethylsuccinate-sulfisoxazole therapy, 18 patients had normal tympanic membranes. Of 11 with middle ear effusion, 7 cleared, 3 had recurrent otitis media within 1 month and 1 had persistent otitis media with effusion. Our experience suggests the efficacy of this combination in otitis media caused by ampicillin-resistant H. influenzae.
Insights
A combination of erythromycin ethylsuccinate and sulfisoxazole effectively treated acute otitis media caused by ampicillin-resistant Haemophilus influenzae. This antibiotic combination offers a viable treatment option for resistant middle ear infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Ampicillin treatment failure in acute otitis media (AOM) is often linked to ampicillin-resistant Haemophilus strains.
- A significant percentage of middle ear isolates show resistance to ampicillin, necessitating alternative therapeutic strategies.
Purpose of the Study:
- To evaluate the efficacy of erythromycin ethylsuccinate combined with sulfisoxazole in treating AOM caused by ampicillin-resistant Haemophilus influenzae.
- To assess treatment outcomes in pediatric patients who previously failed ampicillin therapy.
Main Methods:
- A cohort of 29 children with AOM, predominantly those unresponsive to ampicillin, received a combination therapy of erythromycin ethylsuccinate and sulfisoxazole.
- Middle ear fluid cultures were performed to identify bacterial isolates, with susceptibility testing including beta-lactamase production and minimal inhibitory concentration (MIC) for ampicillin.
- Clinical outcomes were assessed by tympanic membrane status and resolution of middle ear effusion after 10 days of treatment.
Main Results:
- All 29 isolated Haemophilus strains were ampicillin-resistant, with 28 producing beta-lactamase.
- The erythromycin ethylsuccinate-sulfisoxazole combination demonstrated effectiveness, with 18 patients achieving normal tympanic membranes.
- Of 11 patients with middle ear effusion, 7 resolved, while 3 experienced recurrence and 1 had persistent effusion within one month.
Conclusions:
- Erythromycin ethylsuccinate and sulfisoxazole combination therapy is effective for acute otitis media secondary to ampicillin-resistant Haemophilus influenzae.
- This combination provides a valuable treatment alternative for pediatric AOM cases involving ampicillin-resistant bacterial pathogens.
- Further investigation into long-term outcomes and resistance patterns is warranted.