trimethoprim--sulfamethoxazole-drug-combination and Otitis-Media-with-Effusion

In 1995, >5 million episodes of acute otitis media (AOM) accounted for $3 billion in health care expenditures.. To synthesize the literature on the natural history of AOM, the effectiveness of antibiotic treatment in uncomplicated AOM, and the relative effectiveness of specific antibiotic regimens.. Seven electronic databases for articles published between 1966 and March 1999 and reference lists in proceedings, published articles, reports, and guidelines.. Two physicians independently assessed each article. Studies addressing AOM in children 4 weeks to 18 years old were included; those addressing children with immunodeficiencies or craniofacial abnormalities were excluded. Randomized, controlled trials (RCTs) were used to assess antibiotic effectiveness, and RCTs and cohort studies were used to assess the natural history of AOM. Among the 3491 citations identified, 80 (2.3%) met our inclusion criteria.. Two physicians independently abstracted data and assessed the quality of studies using a validated scale for RCTs and 8 quality components for cohort studies.. Random-effects estimates of pooled absolute rate differences of outcomes were derived, and heterogeneity of both the rates and rate differences was assessed. Children with AOM not treated with antibiotics experienced a 1- to 7-day clinical failure rate of 19% (95% confidence interval: 0.10-0.28) and few suppurative complications. When patients were treated with amoxicillin, the 2- to 7-day clinical failure rate was reduced to 7%, a 12% (95% confidence interval: 0.04-0.20) reduction. Adverse effects, primarily gastrointestinal, were more common among children on cefixime than among those on ampicillin or amoxicillin. They were also more common among children on amoxicillin-clavulanate than among those on azithromycin.. The majority of uncomplicated cases of AOM resolve spontaneously without apparent suppurative complications. Ampicillin or amoxicillin confers a limited therapeutic benefit. There is no evidence to support any particular antibiotic regimens as more effective at relieving symptoms. Certain antibiotics are more likely than others to cause diarrhea and other adverse events.

Topics: Acute Disease; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Cohort Studies; Diarrhea; Dose-Response Relationship, Drug; Drug Administration Schedule; Evidence-Based Medicine; Humans; Infant; Otitis Media with Effusion; Penicillins; Randomized Controlled Trials as Topic; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A study of otitis media that requires a test for the comparison of two clustered samples of censored data is described. A method is proposed taking into account the within-subject correlation in the formation of the log-rank statistic.

Topics: Biometry; Child; Child, Preschool; Cluster Analysis; Combined Modality Therapy; Data Interpretation, Statistical; Humans; Infant; Middle Ear Ventilation; Otitis Media with Effusion; Prednisone; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

This study was designed to determine whether treatment with prednisone and trimethoprim-sulfamethoxazole would reduce first year post-operative morbidity in children with chronic otitis media with effusion undergoing tympanostomy tube insertion (intubation). Eighty children ages 6 months to 8 years were enrolled at intubation and randomized from age strata to receive active drugs or placebos for 14 days after surgery. They were examined with pneumatic otoscopy and tympanometry preoperatively and at 3 weeks and 3, 6, 9 and 12 months after surgery. Active drug treatment significantly reduced tube obstruction or extrusion in the first 3 postoperative months compared with placebos (4% vs. 17%, P = .01). However, rates of repeat intubation, otorrhea and recurrence of otitis media did not differ significantly in the two groups. Children with chronic otitis media with effusion treated with intubation may benefit from a 2-week course of prednisone and trimethoprim-sulfamethoxazole at the time of surgery. However, there is no apparent long term benefit of this treatment.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Infant; Male; Middle Ear Ventilation; Minnesota; Morbidity; Otitis Media with Effusion; Postoperative Complications; Prednisone; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

This controlled prospective study was designed to identify predictors for postoperative otorrhea among 157 children with chronic otitis media with effusion undergoing myringotomy and tympanostomy tube placement (intubation). Ear canal disinfection with 70% alcohol or povidone-iodine did not significantly alter ear canal or middle ear effusion bacteriology, or the frequency of otorrhea during the first 7 days after surgery. However, the risk of otorrhea on the second postoperative day was significantly increased by the presence of a bacterial pathogen in the ear canal (relative risk, 2.4), or in the middle ear effusion (relative risk, 1.9), and the presence of inflamed middle ear mucosa at surgery (relative risk, 1.7) after controlling for age, preoperative antibiotics, and postoperative ototopical cortisporin treatment. The use of systemic antimicrobial treatment in children with inflamed middle ear mucosa at surgery or whose ear canal or middle ear effusion cultures are positive for bacterial pathogens might reduce the incidence of post-operative otorrhea in children undergoing intubation for chronic otitis media with effusion.

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Chronic Disease; Disinfection; Drug Therapy, Combination; Female; Humans; Infant; Male; Middle Ear Ventilation; Multivariate Analysis; Otitis Media with Effusion; Otitis Media, Suppurative; Postoperative Care; Prednisone; Preoperative Care; Prospective Studies; Regression Analysis; Trimethoprim, Sulfamethoxazole Drug Combination

This double blind, placebo-controlled trial was designed to determine whether intervention with a stepped regimen of trimethoprim-sulfamethoxazole (TMP-SMX) and prednisone would prevent high risk children from developing chronic otitis media with effusion (OME) and recurrent acute otitis media. Forty-two children were enrolled, assigned to treatment with active drug or placebo and then examined at 2-week intervals. They received TMP-SMX (or placebo) during the first 2 weeks, TMP-SMX and prednisone (or placebo) during Weeks 3 and 4 for persistent OME and TMP-SMX (or placebo) for Weeks 5 and 6 if OME was still unresolved. After treatment 48% of active drug and 14% of placebo subjects resolved OME bilaterally (P less than 0.05). Active drug subjects also had fewer acute otitis media episodes than placebo subjects while receiving study treatment (P less than 0.01). Although this treatment regimen produced short term OME resolution, long term benefits were not demonstrated.

Topics: Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Infant; Male; Otitis Media with Effusion; Prednisone; Risk Factors; Statistics as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

There are various forms of medical treatment for otitis media with effusion (OME) in children. One of these is a four week course of an antibiotic. A trial was carried out comparing cotrimoxazole with amoxicillin-potassium clavulanate in 102 cases with 181 affected ears. In addition this trial used various procedures to increase and monitor compliance, and the results showed that the compliant cases did much better than the noncompliant cases and cotrimoxazole was more effective than amoxicillin-potassium clavulanate. When the ethnic groupings were analysed the compliance was lower for the Maori (24%) and Pacific Islander (29%) than the European (49%). The success rate for the compliant cases whose middle ear effusion resolved in one or both ears had a similar result with Maori (40%), Pacific Islander (60%) and European (71%) probably indicating an increased nonmeasured compliance in the latter.

Topics: Age Factors; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Chi-Square Distribution; Child; Child, Preschool; Chronic Disease; Clavulanic Acids; Drug Administration Schedule; Female; Humans; Infant; Male; New Zealand; Otitis Media with Effusion; Patient Compliance; Trimethoprim, Sulfamethoxazole Drug Combination

Fifty-three patients were enrolled and evaluable in a randomized, double-blinded controlled clinical trial comparing prednisone for 7 days plus trimethoprim-sulfamethoxazole (TMP/SMZ) for 30 days vs. TMP/SMZ alone in treating chronic middle ear effusion (MEE). Clearing of the effusion in both ears or in one when only one was involved was called complete resolution; clearing in one of two affected ears was called partial resolution. The outcomes 2 weeks after initiation of therapy of 26 patients initially treated with prednisone plus TMP/SMZ were complete resolution in 20, partial resolution in three, and unchanged in three. The outcomes in 27 patients initially treated with TMP/SMZ alone were complete resolution in eight, partial resolution in three, unchanged in 13 and development of acute otitis media in three (P less than 0.01 for complete resolution). Two weeks after initiation of therapy, patients with a MEE that failed to clear were crossed over to the alternative regimen. Overall 29 of 41 patients (71%) who received oral prednisone plus TMP/SMZ initially or after the crossover had complete resolution of their middle ear effusion at 2 weeks after starting prednisone and TMP/SMZ. Five of 35 (14%) patients treated with prednisone plus TMP/SMZ and one of six (17%) patients treated with TMP/SMZ alone who had complete resolution at 4 weeks required subsequent referrals for tympanostomy tubes. A course of prednisone for 7 days plus TMP/SMZ for 30 days with monthly follow-up should be considered in children with MEE persisting beyond 6-8 weeks before referral for tympanostomy tube placement.

Topics: Chronic Disease; Double-Blind Method; Drug Therapy, Combination; Humans; Infant; Middle Ear Ventilation; Otitis Media with Effusion; Prednisone; Prognosis; Trimethoprim, Sulfamethoxazole Drug Combination

A randomized, controlled clinical trial was conducted in 76 children to evaluate the efficacy of trimethoprim-sulfamethoxazole for 4 weeks, prednisone for 2 weeks and aluminum ibuprofen suspension for 2 weeks in resolving chronic otitis media with effusion which had persisted for more than 8 weeks. After 2 weeks of treatment resolution rates of chronic otitis media with effusion in the prednisone and trimethoprim-sulfamethoxazole groups were significantly greater than those in the control (no treatment) and ibuprofen groups. After 4 weeks the differences in resolution rates between the control, trimethoprim-sulfamethoxazole and prednisone groups became smaller. After 12 months of follow-up, differences in hearing sensitivity among study groups were not statistically significant, although 83% of patients had a 15-dB or greater hearing loss. Therefore short term antimicrobial and antiinflammatory treatment did not appear to have a long lasting effect on chronic middle ear inflammation.

Topics: Analysis of Variance; Child; Child, Preschool; Chronic Disease; Follow-Up Studies; Hearing Loss; Humans; Ibuprofen; Infant; Otitis Media with Effusion; Prednisone; Randomized Controlled Trials as Topic; Recurrence; Regression Analysis; Trimethoprim, Sulfamethoxazole Drug Combination

We compared the efficacy of amoxicillin with that of the combination drug sulfamethoxazole and trimethoprim in reducing recurrences of acute otitis media (AOM) in a single-blind, randomized, placebo-controlled trial involving 96 children. Each of the children had had three or more episodes of AOM in the preceding 6 months, and 97% (93/96) of them still had unilateral or bilateral effusion at the beginning of the study. During the 6-month study period, 9 (27%) of 33 of the children in the amoxicillin group developed 9 episodes of AOM, 9 (27%) of 33 of the children in the sulfamethoxazole and trimethoprim group experienced 11 episodes of AOM, and 19 (63%) of 30 of the children in the placebo group developed 25 episodes. Young age and day-care attendance characterized children for whom prophylaxis was more efficacious. Overall persistence of middle-ear effusion was shorter in treated children only as a consequence of the reduced number of new episodes of AOM.

Topics: Amoxicillin; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male; Otitis Media; Otitis Media with Effusion; Random Allocation; Recurrence; Seasons; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Infant; Male; Otitis Media with Effusion; Prednisolone; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Otitis media with effusion is the most common cause of hearing loss in children. Prior studies have indicated that viable bacteria may be present in this process. A controlled clinical trial was therefore undertaken to assess the efficacy of antimicrobial agents in the treatment of this disease entity over a four week period. It appears that the use of antibiotics significantly improves the outcome in patients treated for four weeks when compared with patients observed over the same time period.

Topics: Anti-Bacterial Agents; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Ear Canal; Ear, Middle; Humans; Otitis Media; Otitis Media with Effusion; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Child; Chlorpheniramine; Clinical Trials as Topic; Drug Combinations; Follow-Up Studies; Humans; Multi-Ingredient Cold, Flu, and Allergy Medications; Otitis Media; Otitis Media with Effusion; Phenylephrine; Phenylpropanolamine; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Mouth Breathing; Otitis Media; Otitis Media with Effusion; Random Allocation; Snoring; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

AbstractParacoccidioidomycosis is a systemic mycosis caused by

Topics: Adult; Anti-Infective Agents; Ear, Middle; Hearing Loss; Humans; Male; Middle Ear Ventilation; Nasopharynx; Otitis Media with Effusion; Palate, Soft; Paracoccidioides; Paracoccidioidomycosis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

For many years, trimethoprim-sulfamethoxazole (TMP-SMX) has been recommended as an alternative antimicrobial agent for the treatment of children with otitis media (OM). This study analyzed the in vitro activity of TMP-SMX against respiratory pathogens obtained from middle ear fluid of Costa Rican children 6-60 months of age with acute OM, recurrent OM, therapeutic failures and acute OM at risk for having a resistant pathogen. Between 2002 and 2003, a total of 124 middle ear fluid bacterial isolates were analyzed and compared with historic data from 1992 to 1997. A significant increase in the number of TMP-SMX Streptococcus pneumoniae (P = 0.00008)- and Haemophilus influenzae (P = 0.04)-resistant strains was observed during 2002-2003 when compared with strains from 1992-1997.

Topics: Acute Disease; Anti-Bacterial Agents; Costa Rica; Drug Resistance, Microbial; Female; Haemophilus influenzae; Humans; Male; Microbial Sensitivity Tests; Otitis Media with Effusion; Risk Factors; Sampling Studies; Sensitivity and Specificity; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the microbiology of chronic otitis media with effusion in a group of Auckland children. To determine the antimicrobial sensitivities of isolated bacterial pathogens to commonly used antibiotics for this condition.. A descriptive study recruiting subjects from otherwise well children with chronic otitis media with effusion having insertion of ventilation tubes at Starship Children's Health, Auckland. Tympanocentesis was performed, the middle ear aspirate cultured and antimicrobial sensitivities obtained.. Sixty seven children (11mo to 8yr) with chronic otitis media with effusion had tympanocentesis of 105 ears. 38/105 (36%) of the middle ear aspirate cultures were positive. Forty nine organisms were isolated with 10 ears having two or more different bacteria identified. Isolated were 17 Haemophilus influenzae (16 nontype b and 1 type b), 13 Moraxella catarrhalis, nine Streptococcus pneumoniae and 10 'others'. All S pneumoniae(9/9), most H influenzae(14/17) and no M catarrhalis(0/13) were sensitive to amoxycillin. More than 80% of subjects had either a sterile effusion or an organism sensitive to amoxycillin or cotrimoxazole.. Middle ear effusions were culture positive in a third of cases of chronic otitis media with effusion. The commonest organisms were H influenzae nontype b, M catarrhalis and S pneumoniae. This is similar to reports from other countries. Sensitivity data obtained supports the continued recommendation of amoxycillin or cotrimoxazole as first line therapy for the antimicrobial treatment of this condition.

Topics: Amoxicillin; Anti-Bacterial Agents; Child; Child, Preschool; Female; Humans; Infant; Male; Microbial Sensitivity Tests; New Zealand; Otitis Media with Effusion; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Age Factors; Amoxicillin; Drug Combinations; Humans; Infant; Infant, Newborn; Middle Ear Ventilation; Otitis Media; Otitis Media with Effusion; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Acute otitis media is commonly caused by pneumococcus and Hemophilus influenzae. Amoxicillin is recommended as the initial therapy when the causative agent has not been identified. If amoxicillin is ineffective, cefaclor is useful. Decongestants are of little proven value. Since most middle ear effusions resolve spontaneously in three to four months, surgical treatment is seldom indicated.

Topics: Anti-Bacterial Agents; Bacterial Vaccines; Child; Child, Preschool; Drug Combinations; Hearing Disorders; Humans; Infant; Mass Screening; Middle Ear Ventilation; Otitis Media; Otitis Media with Effusion; Recurrence; Streptococcus pneumoniae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Branhamella catarrhalis--a Gram-negative diplococcus--differs biochemically from other Neisseriaceae and possesses a specific protein with antigenic properties. Although scattered cases of meningitis and endocarditis have been reported since 1907, B. catarrhalis has been considered a non-pathogenic, pharyngeal commensal. However, relatively recent reports have shown B. catarrhalis to play a significant role in the etiology of otitis media and bronchopulmonary infections. Some reports also indicate a pathogenic role in sinusitis and longstanding cough in children, and in acute laryngitis in adults. B. catarrhalis is susceptible to co-trimoxazole, erythromycin, cephalosporins and tetracyclines. Most strains are also susceptible to penicillin, but the frequency of beta-lactamase producing B. catarrhalis has increased from 4% to 25% during the last six years (Sweden). First choice antibiotics in infections with penicillin-resistant strains would be erythromycin and co-trimoxazole.

Topics: Anti-Bacterial Agents; Bacterial Infections; Drug Combinations; Drug Resistance, Microbial; Erythromycin; Humans; Laryngitis; Microbial Sensitivity Tests; Neisseria; Otitis Media with Effusion; Respiratory Tract Infections; Sinusitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination