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Bacteriologic efficacy of a three-day intramuscular ceftriaxone regimen in nonresponsive acute otitis media
E Leibovitz1, L Piglansky, S Raiz
1Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. eugenel@bgumail.bgu.pc.il
Insights
A 3-day intramuscular ceftriaxone treatment effectively eradicated bacteria in children with nonresponsive acute otitis media. This regimen showed high efficacy against common pathogens, including penicillin-resistant Streptococcus pneumoniae.
Area of Science:
- Pediatric infectious diseases
- Bacteriology
- Pharmacology
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Nonresponsive AOM cases require effective treatment strategies.
- Previous antibiotic treatments often fail in recurrent or persistent AOM.
Purpose of the Study:
- To evaluate the bacteriologic efficacy of a 3-day intramuscular ceftriaxone regimen.
- To assess treatment outcomes in children with culture-proven nonresponsive AOM.
- To determine the effectiveness against specific bacterial pathogens, including resistant strains.
Main Methods:
- Prospective study of 92 children (3-36 months) with nonresponsive AOM.
- Treatment with intramuscular ceftriaxone (50 mg/kg/day) for 3 days.
- Middle ear fluid cultures obtained via tympanocentesis at enrollment and Days 4-10.
Main Results:
- High bacteriologic eradication rate of 95% (100/105 isolates).
- Effective against Haemophilus influenzae (100%), Streptococcus pneumoniae (92%), and Streptococcus pyogenes (100%).
- Demonstrated efficacy against penicillin-intermediate resistant S. pneumoniae (82% success).
Conclusions:
- A 3-day intramuscular ceftriaxone regimen is efficacious for nonresponsive AOM.
- Further research is needed to determine optimal duration and efficacy against highly penicillin-resistant S. pneumoniae.
Objective:
To determine the bacteriologic efficacy of ceftriaxone in nonresponsive acute otitis media in children.
Methods:
In a prospective study 92 patients ages 3 to 36 months (median, 11 months) with culture-proved nonresponsive acute otitis media were studied from January, 1995, through August, 1997. The patients were treated with intramuscular ceftriaxone (50 mg/kg/l/day) for 3 days. Middle ear fluid was aspirated for culture by tympanocentesis on day of enrollment (Day 1); a second tap was performed on Days 4 to 10. Additional middle ear fluid cultures were obtained if clinical relapse occurred. Bacteriologic failure was defined by positive culture on Days 4 to 10. Patients were followed until Day 17+/-2. Susceptibility was measured by E test.
Results:
The main drugs administered before enrollment were amoxicillin (38%), amoxicillinclavulanate (25%) and cefaclor (20%). Organisms recovered (n=105) were: Haemophilus influenzae, 54; Streptococcus pneumoniae, 47; Moraxella catarrhalis, 2; and Streptococcus pyogenes, 2. Thirty-four (72%) of the 47 S. pneumoniae isolates were intermediately resistant to penicillin (MIC 0.1 to 1.0 microg/ml), but all were susceptible to ceftriaxone (MIC < 0.5 microg/ml). Bacteriologic eradication was achieved in 100 of 105 (95%) cases: 54 of 54 (10O%) H. influenzae, 43 of 47 (92%) S. pneumoniae, 1 of 2 (50%) M. catarrhalis and 2 of 2 (100%) S. pyogenes. Bacteriologic success (with no relapse) occurred in 13 of 13 (100%) penicillin-susceptible S. pneumoniae vs. 28 of 34 (82%) S. pneumoniae intermediately resistant to penicillin (4 cases of bacteriologic failure and 2 cases of relapse).
Conclusion:
A 3-day intramuscular ceftriaxone regimen is efficacious for the treatment of nonresponsive acute otitis media. The optimal duration of treatment in cases of nonresponsive acute otitis media and whether ceftriaxone is efficacious for the treatment of nonresponsive otitis media caused by S. pneumoniae highly resistant to penicillin is yet to be determined.