cefditoren and Otitis-Media

Otitis media (OM) is one of the most common infections in children, Streptococcus pneumoniae and nontypable Haemophilus influenzae being the two most common pathogens isolated in the middle ear fluid (MEF) of children with OM. Cefditoren is a third-generation cephalosporin with broad-spectrum antibacterial activity, including activity against those pathogens commonly causing OM, with enhanced stability against common β-lactamases. The main objective of this study was to evaluate the in vitro activity of cefditoren against pathogens collected from the MEF of Costa Rican children with OM between 2006 and 2011. A total of 715 samples were analyzed. Among the 89 S. pneumoniae strains that were penicillin-nonsusceptible, only 7% were cefditoren-resistant according to Spanish Regulatory Agency criteria; among the H. influenza and M. catarrhalis isolates obtained, 100 and 90% of the isolates, respectively, were cefditoren-susceptible. MIC50/90 against the 207 PCV-13 S. pneumoniae serotyped strains and the 79 serotypes not covered by PCV-13 for cefditoren were 0.03/1 and 0.03/0.12 mg/l, respectively. For both amoxicillin-susceptible and resistant H. influenzae strains, the MIC range against cefditoren was from ≤0.015 to 0.06 mg/l as well. In conclusion, the confirmation of the wide spectrum of activity of cefditoren and its intrinsic strength against resistant strains allows us to suggest that cefditoren might be included as one of the best choices among antibiotics that are widely used in empiric therapy for OM in pediatric patients.

Topics: Anti-Bacterial Agents; Cephalosporins; Child; Child, Preschool; Costa Rica; Drug Resistance, Multiple, Bacterial; Ear, Middle; Female; Humans; Male; Microbial Sensitivity Tests; Otitis Media; Streptococcus pneumoniae

Topics: Acute Disease; Adolescent; Adult; Aged; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections; Drug Resistance, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Middle Aged; Otitis Media; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae; Treatment Outcome

Topics: Acute Disease; Ampicillin Resistance; beta-Lactamases; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Otitis Media; Penicillin Resistance; Pneumococcal Infections; Prospective Studies; Respiratory Tract Infections; Streptococcus pneumoniae; Treatment Outcome

Topics: Acute Disease; Ampicillin; Anti-Bacterial Agents; beta-Lactam Resistance; Carbapenems; Cephalosporins; Child, Preschool; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Japan; Microbial Sensitivity Tests; Multilocus Sequence Typing; Naphthyridines; Otitis Media; Pneumococcal Vaccines; Quinolones; Streptococcus pneumoniae; Vaccines, Conjugate

To study the influence of resistance phenotypes (based on sentinel antibiotics: penicillin and amoxicillin with/without clavulanate) on the cefuroxime versus cefditoren susceptibility of Streptococcus pneumoniae and Haemophilus influenzae recovered from children with acute otitis media.. Middle ear isolates (193 S. pneumoniae and 114 H. influenzae) received in the Spanish Reference Laboratory (Instituto de Salud Carlos III) were tested. Antimicrobial susceptibility to penicillin, amoxicillin with/without clavulanate, cefuroxime and cefditoren was determined by agar dilution using Mueller-Hinton agar supplemented with 5% sheep blood for S. pneumoniae and Haemophilus Test Medium for H. influenzae. Strains were classified according to penicillin susceptibility (S. pneumoniae) or beta-lactamase production (H. influenzae).. The decrease in penicillin susceptibility of S. pneumoniae (from the susceptible to the resistant category) decreased amoxicillin and cefuroxime susceptibility rates from 100% to 34% and 0%, respectively. All pneumococcal strains were inhibited by 0.5 mg/L cefditoren, including those from penicillin-resistant serotypes 14, 23F, 6B and 9V with higher amoxicillin versus penicillin MICs. Susceptibility rates of beta-lactamase-positive H. influenzae strains were 93.8% and 85.4% to amoxicillin/clavulanate and cefuroxime, respectively. Resistance to amoxicillin/clavulanate (MIC>or=8/4 mg/L) was 12.1% (8 out of 66) and 6.3% (3 out of 48) in beta-lactamase-negative and -positive strains, respectively. All H. influenzae strains were inhibited by

Topics: Acute Disease; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Cefuroxime; Cephalosporins; Child; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Otitis Media; Phenotype; Streptococcus pneumoniae

This study was conducted to determine cefditoren (CDTR) transport kinetics between plasma and middle ear fluid (MEF) by characterizing influx (CLin) and efflux (CLout) clearances expressed in terms of unbound concentrations and their ratio. Simultaneous intravenous bolus and intramiddle-ear dose were administered to two groups of chinchillas: normal control and infected. In vivo microdialysis was employed to determine protein-unbound CDTR levels in MEF. Compartmental and noncompartmental analysis was performed. Parameters determined in both groups were compared to assess the effect of infection and inflammation on CDTR distribution kinetics. CLin and CLout estimates obtained by compartmental and noncompartmental analysis agreed well. The calculated CLin/CLout ratio was 0.76 +/- 0.23 and 0.56 +/- 0.25 in normal (n = 9) and infected (n = 6) animals, respectively. The 95% confidence interval of this ratio in both groups does not include unity. Statistical tests showed no difference (p > 0.05) in CLin, CLout, and their ratio between the two groups. In conclusion, middle ear infection and inflammation does not affect CDTR distribution. The CLin/CLout ratio determined in chinchillas compares well with values estimated from data in pediatric patients. An active efflux mechanism in middle ear mucosa may be involved in CDTR distribution in MEF.

Topics: Animals; Anti-Bacterial Agents; Area Under Curve; Biological Transport; Cephalosporins; Chinchilla; Disease Models, Animal; Ear, Middle; Injections, Intravenous; Instillation, Drug; Male; Microdialysis; Otitis Media; Time Factors

Topics: Acute Disease; Amoxicillin; Cephalosporins; Child, Preschool; Community-Acquired Infections; Humans; Infant; Middle Ear Ventilation; Otitis Media; Penicillin Resistance; Pneumococcal Infections; Recurrence; Retrospective Studies; Streptococcus pneumoniae; Treatment Outcome

Topics: Acute Disease; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Nasopharynx; Otitis Media; Penicillin Resistance; Pneumococcal Infections; Pulse Therapy, Drug; Retrospective Studies; Severity of Illness Index; Streptococcus pneumoniae; Treatment Outcome

Topics: Acute Disease; Ampicillin Resistance; beta-Lactamases; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections; Drug Resistance, Bacterial; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Otitis Media; Penicillin Resistance; Pneumococcal Infections; Respiratory Tract Infections; Streptococcus pneumoniae

Topics: Ampicillin Resistance; Anti-Bacterial Agents; beta-Lactams; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Lactams; Otitis Media; Penicillin Resistance; Pneumococcal Infections; Respiratory Tract Infections; Retrospective Studies; Streptococcus pneumoniae; Treatment Outcome

Topics: Anti-Bacterial Agents; beta-Lactams; Cephalosporins; Child Day Care Centers; Child, Preschool; Drug Resistance, Bacterial; Humans; Infant; Japan; Lactams; Otitis Media; Penicillin G; Serotyping; Siblings; Streptococcus pneumoniae