One dose ceftriaxone vs. ten days of amoxicillin/clavulanate therapy for acute otitis media: clinical efficacy and change in nasopharyngeal flora

Cohen, Robert; Navel, M.; Grunberg, Jean; Boucherat, M.; Geslin, P.; Derriennic, M.; Pichon, François; Goehrs, Jean-Marie

doi:10.1097/00006454-199905000-00002

Cited by 78 publications

(38 citation statements)

References 25 publications

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“…In~36 % of our subjects, NTHi strains persisted in the NP or middle ear after antibiotic treatment, a finding similar to that of van Schilfgaarde et al (1999) and others (Cohen et al, 1999;Dabernat et al, 1998). Strains that persist in the NP after antibiotic therapy may be the result of antibiotic resistance or other unique characteristics of the strain or could be a consequence of lower levels of antibiotic in a host due to suboptimal absorption of the drug (Pichichero et al, 2008;Pichichero & Reed, 2009).…”

Section: Discussionsupporting

confidence: 91%

“…Inc means it was not possible to obtain a sequence for all seven genes for that isolate and therefore the ST was not obtained, but partial analysis clearly allowed us to determine that the strain was different from the other strains in that particular child. MLST types in invasive disease, so we cannot determine whether ST146 and ST685 are associated or not with invasive disease.In~36 % of our subjects, NTHi strains persisted in the NP or middle ear after antibiotic treatment, a finding similar to that of van Schilfgaarde et al (1999) and others (Cohen et al, 1999;Dabernat et al, 1998). Strains that persist in the NP after antibiotic therapy may be the result of antibiotic resistance or other unique characteristics of the strain or could be a consequence of lower levels of antibiotic in a host due to suboptimal absorption of the drug (Pichichero et al, 2008;Pichichero & Reed, 2009).…”

supporting

confidence: 91%

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Phylogenetic relatedness and diversity of non-typable Haemophilus influenzae in the nasopharynx and middle ear fluid of children with acute otitis media

Kaur

Chang

et al. 2011

Journal of Medical Microbiology

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The phylogenetic relationships of non-typable Haemophilus influenzae (NTHi) strains prospectively isolated from healthy children and children with acute otitis media (AOM) were analysed using multilocus sequence typing (MLST). A total of 165 NTHi isolates were collected over a 3.5 year time frame during 2006 through 2009. The strains were tested for b-lactamase production; 28.5 % were positive. Seventy different NTHi sequence types (STs) were identified of which 29 (41.4 %) were novel. NTHi strains did not show any phylogenetic grouping or clustering among asymptomatic colonizing strains or strains that caused AOM, or based on b-lactamase enzyme production. Evaluation of triplets and other siblings over time demonstrated relatively frequent genetic exchanges in NTHi isolates in vivo in a short time frame and subsequent transfer among children in a family. Comparison of the MLST STs isolated at different time points showed that in~85 % of the nasopharynx (NP) colonizations, NTHi strains cleared from the host within 3 months, that sequential colonization in the same child involved different strains in all cases except one, and that NP and middle ear isolates were identical STs in 84 % of cases. In this first study of its type to our knowledge, we could not identify predominant MLST types among strains colonizing the NP versus those causing AOM or expressing a b-lactamase enzyme conferring penicillin resistance in children. INTRODUCTIONNon-typable Haemophilus influenzae (NTHi) is an important human-specific pathogen colonizing the nasopharynx (NP) of the upper respiratory tract (Faden et al., 1995; Murphy et al., 2009). NTHi strains are rarely associated with invasive disease in children, but they are associated with respiratory tract infections in both children and adults (Murphy, 2003;Kyd & Cripps, 1999). NP colonization with NTHi is an important risk factor for developing disease (Faden et al., 1997). Children frequently NP-colonized by NTHi are more likely to develop acute otitis media (AOM) than less frequently colonized children (Faden et al., 1997; Harabuchi et al., 1994). Simultaneous detection of multiple isolates of NTHi from the same sample has been reported among aboriginal children with otitis media (Smith-Vaughan et al., 1996), among otitis-prone children in day care centres (St Sauver et al., 2000) and in cystic fibrosis patients (Bandi et al., 2001; Murphy et al., 1999), which may result from inadequate clearance of colonizing bacteria, exposure to multiple circulating strains or in vivo genetic recombinations in a specific host. It is not known whether NTHi isolates that express b-lactamases (responsible for resistance to b-lactam antibiotics such as penicillins, cephamycins and carbapenems) are phylogenetically related. Various studies of Streptococcus pneumoniae have shown phylogenetic relationships among antibiotic-resistant strains (Beall et al., 2006;Hanage et al., 2009;Porat et al., 2004;Xu et al., 2009). In this study, we explored whether or not NTHi shows genetic relatedness in relation...

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Section: Discussionsupporting

confidence: 91%

supporting

confidence: 91%

Phylogenetic relatedness and diversity of non-typable Haemophilus influenzae in the nasopharynx and middle ear fluid of children with acute otitis media

Kaur

Chang

et al. 2011

Journal of Medical Microbiology

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“…55 A single 50-mg/kg dose of ceftriaxone, given either intravenously or intramuscularly, can be used for children who are vomiting, unable to tolerate oral medication, or unlikely to be adherent to the initial doses of antibiotic. [62][63][64] The 3 major bacterial pathogens involved in acute bacterial sinusitis are susceptible to ceftriaxone in 95% to 100% of cases. 56,58,59 If clinical improvement is observed at 24 hours, an oral antibiotic can be substituted to complete the course of therapy.…”

Section: Kas Profilementioning

confidence: 99%

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Wald,

Applegate,

Bordley

et al. 2013

Pediatrics

446

368

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OBJECTIVE: To update the American Academy of Pediatrics clinical practice guideline regarding the diagnosis and management of acute bacterial sinusitis in children and adolescents. METHODS: Analysis of the medical literature published since the last version of the guideline (2001). RESULTS: The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection (URI) presents with (1) persistent illness (nasal discharge [of any quality] or daytime cough or both lasting more than 10 days without improvement), (2) a worsening course (worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement), or (3) severe onset (concurrent fever [temperature ≥39°C/102.2°F] and purulent nasal discharge for at least 3 consecutive days). Clinicians should not obtain imaging studies of any kind to distinguish acute bacterial sinusitis from viral URI, because they do not contribute to the diagnosis; however, a contrast-enhanced computed tomography scan of the paranasal sinuses should be obtained whenever a child is suspected of having orbital or central nervous system complications. The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course. The clinician should either prescribe antibiotic therapy or offer additional observation for 3 days to children with persistent illness. Amoxicillin with or without clavulanate is the first-line treatment of acute bacterial sinusitis. Clinicians should reassess initial management if there is either a caregiver report of worsening (progression of initial signs/symptoms or appearance of new signs/symptoms) or failure to improve within 72 hours of initial management. If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic or initiate antibiotic treatment of the child initially managed with observation. CONCLUSIONS: Changes in this revision include the addition of a clinical presentation designated as “worsening course,” an option to treat immediately or observe children with persistent symptoms for 3 days before treating, and a review of evidence indicating that imaging is not necessary in children with uncomplicated acute bacterial sinusitis.

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“…This regimen has been shown to be clinically equivalent to standard therapy with amoxicillin, 8,9 cefaclor, 10 trimethoprim/sulfamethoxazole, 11 amoxicillin/clavulanate, 12 and high-dose amoxicillin/clavulanate. 13 However, in 1 large, unpublished trial, 14 standard-dose amoxicillin/clavulanate was shown to be more effective than single-dose ceftriaxone. Despite published evidence supporting single-dose ceftriaxone for the treatment of AOM, obvious disadvantages are the pain, inconvenience, and risk of needle-stick injury associated with use of an injectable agent, and the potential selection of bacterial resistance to a group of agents (cephalosporins) commonly used for the treatment of life-threatening diseases in children.…”

Section: Introductionmentioning

confidence: 99%

A pilot study of single-dose azithromycin versus three-day azithromycin or single-dose ceftriaxone for uncomplicated acute otitis media in children

Arguedas¹,

Loaiza²,

Pérez³

et al. 2003

Current Therapeutic Research

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Background: The pharmacokinetic profile of azithromycin supports its use as single-dose therapy for uncomplicated acute otitis media (AOM) in children.Objective: This study was designed to (1) compare the safety of single-dose oral azithromycin, 3 daily doses of oral azithromycin, and a single dose of intramuscular ceftriaxone for the treatment of uncomplicated AOM in children, and (2) provide preliminary efficacy data to support initiation of a larger, comparative trial of single-dose azithromycin for the treatment of uncomplicated acute otitis media in children.Methods: In this single-center pilot study, children with uncomplicated AOM were randomly assigned to receive single-dose oral azithromycin (30 mg/kg), 3-day oral azithromycin (10 mg/kg once daily), or single-dose intramuscular ceftriaxone (50 mg/kg). Tympanocentesis was performed before administration of the first dose, and clinical response was assessed on days 14-15 and 28-30.Results: Between September 1995 and May 1997, 198 children (mean age, 2.5 years) were enrolled. All of the patients were evaluable for the safety and clinical intent-to-treat (ITT) analyses, and 98 were evaluable for the microbiologic ITT analysis. On day 14-15, rates of clinical success (cure or improvement) for the 3 treatment groups were: 62/64 (97%) for single-dose azithromycin, 60/63 (95%) for 3-day azithromycin, and 61/62 (98%) for single-dose ceftriaxone. On day 28-30, the corresponding clinical success rates were 61/65 (94%), 61/66 (92%), and 62/64 (97%). For the 98 microbiologically evaluable patients, clinical success rates at day 14-15 were 28/30 (93%) for single-dose azithromycin, 31/35 (89%) for 3-day azithromycin, and 33/33 (100%) for single-dose ceftriaxone. On day 28-30, the corresponding clinical success rates were 27/30 (90%), 30/35 (86%), Presented in part at the 4th International Conference on the Macrolides, Azalides, Streptogramins, and Ketolides (ICMASK), Barcelona, Spain, January 21-23, 1998.Accepted for publication July 1, 2003July 1, . doi:10.1016July 1, /j.curtheres.2003.005 Reproduction in whole or part is not permitted.0011-393X/03/$19.00 A16Copyright ą 2003 Excerpta Medica, Inc. A. Arguedas et al.and 32/33 (97%). Treatment-related adverse event rates for single-dose azithromycin, 3-day azithromycin, and single-dose ceftriaxone were 10.6%, 9.1%, and 9.1%, respectively. Conclusion: In this pilot study comparing single-dose azithromycin, 3-day azithromycin, and single-dose ceftriaxone for the treatment of uncomplicated AOM in children, no differences were detected among the 3 regimens. (Curr Ther Res Clin Exp. 2003;64[Suppl A]:A16-A29)

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One dose ceftriaxone vs. ten days of amoxicillin/clavulanate therapy for acute otitis media: clinical efficacy and change in nasopharyngeal flora

Cited by 78 publications

References 25 publications

Phylogenetic relatedness and diversity of non-typable Haemophilus influenzae in the nasopharynx and middle ear fluid of children with acute otitis media

Phylogenetic relatedness and diversity of non-typable Haemophilus influenzae in the nasopharynx and middle ear fluid of children with acute otitis media

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

A pilot study of single-dose azithromycin versus three-day azithromycin or single-dose ceftriaxone for uncomplicated acute otitis media in children

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