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Management of acute otitis media caused by resistant pneumococci in infants
1Department of Pediatric ENT, Hôpital d'Enfants Armand Trousseau, Paris, France. orl.trousseau@trs.ap-hop-paris.fr
Objectives:
To assess the clinical outcome and risk of failure after oral vs. intravenous treatment in otitis media caused by penicillin-resistant pneumococci. To determine the possible correlations between pneumococcal minimal inhibitory concentration (MIC) to penicillin and clinical outcome.
Design:
Retrospective study of 156 cases collected between 1993 and 1995. Mean follow-up: 5 months. Setting. Two tertiary academic medical centers in Paris, France.
Patients And Methods:
Pneumococcus was isolated from 191 of 570 ear samples obtained from children with otitis media and shown to be penicillin-resistant in 156. Medical history, antibiotic therapy during the previous 3 months and day-care center attendance were reviewed. For the current episode microbiologic characteristics of the isolated strains, type of treatment, therapy efficacy and clinical outcome were analyzed. Patients were predominantly young (76.3% were <1 year old) and bacteriologic samples were taken mainly because of previous treatment failure.
Results:
Among 156 children with pneumococcal penicillin-resistant otitis media, 72.2% attended day-care centers, 71.8% had been previously treated with aminopenicillin and 52.5% with cephalosporins. Failure of previous empirical oral therapy was noted in 84% (one-third of these had been receiving amoxicillin-clavulanate). Patients treated intravenously had had a more protracted otitis but no greater number of previous episodes of acute otitis media than those receiving oral therapy. Acute mastoiditis occurred in 4 infants resulting in mastoidectomy. Oral treatment (mainly with high dose amoxicillin,120 to 150 mg/kg/day) and intravenous therapy (cephalosporin or glycopeptide) had been used in 59 and 41%, respectively. Mean duration of therapy was 10.7 days. Three failures (1.9%) and 10 recurrences (6.4%, average 28 days) occurred. No statistical difference was found between intravenous and oral therapy with respect to risk of recurrence. A high penicillin MIC value was correlated with previous antibiotic treatment but not with clinical outcome.
Conclusions:
Oral therapy appears to be as effective as intravenous therapy for the treatment of penicillin-resistant pneumococcal otitis media. Intravenous treatment should not necessarily be dictated by the penicillin susceptibility value but should be considered in cases of failure to thrive, persistent otitis or other complications.
Insights
Oral therapy is as effective as intravenous therapy for treating penicillin-resistant pneumococcal otitis media. Treatment choice should consider clinical factors, not just penicillin susceptibility, for better outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Otitis media is a common childhood infection, frequently caused by Streptococcus pneumoniae.
- Penicillin-resistant strains of S. pneumoniae pose a significant treatment challenge.
- Previous antibiotic exposure and day-care attendance are risk factors for resistant infections.
Purpose of the Study:
- To compare the clinical outcomes of oral versus intravenous antibiotic treatment for otitis media caused by penicillin-resistant pneumococci.
- To investigate the correlation between penicillin's minimal inhibitory concentration (MIC) and treatment success.
Main Methods:
- Retrospective analysis of 156 pediatric cases of penicillin-resistant pneumococcal otitis media treated between 1993-1995.
- Review of patient medical history, prior antibiotic use, and day-care attendance.
- Analysis of treatment efficacy and clinical outcomes for both oral and intravenous therapies.
Main Results:
- Oral and intravenous therapies showed no significant difference in recurrence rates for penicillin-resistant pneumococcal otitis media.
- High penicillin MIC values correlated with prior antibiotic treatment but not clinical outcome.
- Treatment failures (1.9%) and recurrences (6.4%) were low in both groups.
Conclusions:
- Oral antibiotic therapy is a viable and effective alternative to intravenous treatment for penicillin-resistant pneumococcal otitis media.
- Intravenous therapy may be reserved for complicated cases, such as failure to thrive or persistent otitis, rather than solely based on penicillin susceptibility.