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

Septic arthritis of the temporomandibular joint (SATMJ) is an extremely rare disease with characteristic features of preauricular pain, swelling, redness, and malocclusion. The present report describes a case of SATMJ derived from otitis media, which resulted in a good outcome. We also reviewed the English and Japanese literature with special interest in etiology. It is generally agreed that contiguous or distant infection and trauma are common etiological factors of SATMJ. So far, these etiological factors are mainly discussed based on hypotheses rather than sufficient evidence. Therefore, in many past cases, accurate causes were not identified. To our knowledge, our case is the third report of SATMJ following otitis media. In addition, this is the first case in which the pathogenic bacterium responsible for the otitis media was the definite cause of the SATMJ. Cases of SATMJ are sometimes misdiagnosed with otitis media, and SATMJ derived from otitis media is extremely rare. Dentists and otolaryngologists should collaborate for the management of this disease as needed.

Topics: Abscess; Aged, 80 and over; Arthritis, Infectious; Combined Modality Therapy; Diagnosis, Differential; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Otitis Media; Staphylococcal Infections; Temporomandibular Joint Disorders; Therapeutic Irrigation; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Wegener's granulomatosis (WG) is a rare disease among paediatric patients. Chronic otitis media with or without facial nerve dysfunction is a known manifestation of the disease among adults. A case of a 15-year-old boy with WG, whose initial symptoms were acute otitis media and facial nerve paralysis, is presented. The otorhinolaryngological manifestations, as well as diagnostic and current treatment modalities in paediatric patients with WG, are discussed.

Topics: Administration, Oral; Adolescent; Adult; Anti-Infective Agents, Urinary; Anti-Inflammatory Agents; Antineoplastic Agents, Alkylating; Biopsy; Chronic Disease; Cyclophosphamide; Diagnosis, Differential; Drug Therapy, Combination; Ear, Middle; Facial Nerve; Facial Paralysis; Granulomatosis with Polyangiitis; Humans; Injections, Intravenous; Male; Otitis Media; Prednisone; Severity of Illness Index; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Turbinates

The major problems encountered in the antibiotic therapy of acute otitis media (AOM) are the tremendous increase in the resistance to antibiotics of its main pathogens and the lack of tight criteria (taking into consideration, as a major determinant, the eradication of the pathogens from the middle ear fluid) in the selection of the appropriate antibiotic drugs for the treatment of this disease. Future drugs for the treatment of AOM will have to be approved only after their in vivo microbiological efficacy for each major pathogen is documented. This documentation will be provided by more antibiotic studies with bacteriological outcome using the double-tympanocentesis method and stratifying the AOM patients by age and initial clinical severity. Judicious use of antibiotics for the treatment of AOM will have a major impact on society, leading to a less frequent but more skilled administration of the most effective drugs.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Drug Resistance, Microbial; Humans; Macrolides; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

To review and summarize recent advances in the treatment and prevention of otitis media (OM).. A MEDLINE search (1996-March 2000) was performed to identify relevant primary and review articles. References from these articles were also reviewed if deemed important.. English-language primary and review articles focusing on the treatment and prevention of acute otitis media (AOM) were included. Studies focusing exclusively on OM with effusion or serous OM and chronic suppurative OM were excluded. Information regarding prevention and drug therapy was reviewed, with an emphasis placed on advances made in the last two years.. Recently, an expert panel of the Centers for Disease Control and Prevention recommended use of only three of 16 systemic antibiotics approved by the Food and Drug Administration for treatment of AOM: amoxicillin, cefuroxime axetil, and ceftriaxone. Controversy exists over the importance of key selection factors used by the expert panel in determining which antibiotics to recommend in a two-step treatment algorithm, that is, in vitro data, pharmacodynamic profiles, and necessity for coverage of drug-resistant Streptococcus pneumoniae at all steps of empiric treatment. Additional antibiotic and patient selection factors useful for individualizing therapy include clinical efficacy, adverse effects, frequency and duration of administration, taste, cost, comorbid infections, and ramifications should bacterial resistance develop to the chosen antibiotic. Presumed or past patient/caregiver adherence (especially when antibiotic failure has occurred) is also paramount in selecting antibiotic therapy. A three-step treatment algorithm for refractory AOM that employs amoxicillin, trimethoprim/sulfamethoxazole (TMP/SMX), or high-dose amoxicillin/clavulanate (depending on the prior dose of and adherence to amoxicillin therapy), and ceftriaxone or tympanocentesis at steps 1, 2, and 3, respectively, appears rational and cost-effective. The recent upsurge in antimicrobial resistance is highlighted, and recommendations are presented for the treatment of AOM and prevention of recurrent otitis media (rAOM).. Amoxicillin remains the antibiotic of choice for initial empiric treatment of AOM, although the traditional dosage should be increased in patients at risk for drug-resistant S. pneumoniae. In cases refractory to high-dose amoxicillin, TMP/SMX should be prescribed if adherence to prior therapy seemed good or complete, or high-dose amoxicillin/clavulanate if adherence was incomplete or questionable. Ceftriaxone should be reserved as third-line treatment. The increasing prevalence of drug-resistant S. pneumoniae emphasizes the importance of alternative medical approaches for the prevention of OM, as well as judicious antibiotic use in established cases. Removal of modifiable risk factors should be first-line therapy for prevention of rAOM. We support the use of conjugate pneumococcal vaccine per guidelines for prevention of rAOM from the Advisory Committee on Immunization Practice of the Centers for Disease Control and Prevention, with consideration given to influenza vaccine for cases of rAOM that historically worsen during the flu season. Sulfisoxazole prophylaxis should be reserved for children who are immunocompromised, have concurrent disease states exacerbated by AOM, or meet the criteria of rAOM despite conjugate pneumococcal and influenza vaccination. Therapy should be intermittent, beginning at the first sign of an upper respiratory infection, and should continue for 10 days. The invasive nature and risks of anesthesia relegate myringotomy, tympanostomy tubes, and adenoidectomy to last-line therapies for rAOM.

Topics: Amoxicillin; Anti-Infective Agents; Antibiotic Prophylaxis; Humans; Otitis Media; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination

The last decade is characterized by the increase in antibiotic resistance among respiratory bacterial pathogens in the presence of only modest progress in the development of new antibacterial agents to overcome this resistance. A series of recent studies show clearly that the increased resistance among the main AOM pathogens (namely Streptococcus pneumoniae and Haemophilus influenzae) is associated with a dramatic decrease in bacteriologic response to antibiotic treatment, which in turn has an impact on clinical response. Thus, the individual patient is affected by the increasing antibiotic resistance. Moreover, the society as a whole is now also affected because the carriage and spread of antibiotic resistant AOM pathogens is remarkably impacted by antibiotic treatment. New studies show the remarkable ability of antibiotics to rapidly promote nasopharyngeal carriage and spread of antibiotic-resistant AOM pathogens. In these studies, the increase in carriage of antibiotic resistant S. pneumoniae is shown already after 3-4 days from initiation of antibiotic treatment and may last for weeks to months after treatment. Children carrying antibiotic-resistant organisms transmit those organisms to their family and to their day care centers and thus a vicious cycle is created in which increased antibiotic resistance with decreased response leads to increased antibiotic use, which in turn leads to further increase in resistance. New antibiotics are not likely to improve this situation. It is clear that the challenge in the next decade is to prevent AOM rather than to treat it. Efforts to prevent AOM include improved environmental factors, immunization with bacterial and viral vaccines and some creative measures such as prevention of colonization and attachment to epithelium of AOM pathogens. Whether these efforts will prove successful or, even if successful, will only modify the clinical and bacteriologic picture presenting new challenges, only time will tell.

Topics: Anti-Bacterial Agents; Bacterial Adhesion; Carrier State; Child; Child, Preschool; Drug Resistance, Microbial; Drug Resistance, Multiple; Drug Utilization; Environment; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Infant; Nasopharynx; Otitis Media; Pneumococcal Infections; Retrospective Studies; Streptococcal Vaccines; Streptococcus pneumoniae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination; Viral Vaccines

Pneumocystis carinii (PC) otitis is a rare opportunistic infection of the acquired immunodeficiency syndrome (AIDS). Initially hearing loss and otalgia occur with thickening of the tympanic membrane and the bordering skin of the ear canal. Otorrhea, ear polyps, perforation of tympanic membrane, destruction of mastoidal bone, and participation of cranial nerves are observed. Diagnosis is established histologically. The treatment of the parasite is by trimethoprim-sulfamethoxazole combinations. The immunological situation seems to be better than in PC pneumonia. Due to the underlying immunological incompetence the infection can not be expected to limit itself. To prevent severe complications as sequestrating mastoiditis, early diagnosis and specific surgical and medical treatment are necessary.

Topics: Adult; AIDS-Related Opportunistic Infections; Combined Modality Therapy; Diagnosis, Differential; Ear, Middle; Humans; Male; Otitis; Otitis Media; Pneumocystis Infections; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Mycobacterium fortuitum is a rarely reported cause of otitis media and mastoiditis. We report such a case recently seen at our institution and review the four previously published cases of this disease entity. Amikacin is recommended in the current medical literature as empirical treatment of disease due to M. fortuitum, but the isolate from our patient showed high-level resistance to amikacin, which is rare in clinical isolates of this species; this resistance was probably related to prior treatment with topical aminoglycosides. Our patient's infection responded to a 12-month course of therapy with clarithromycin and trimethoprim-sulfamethoxazole.

Topics: Adolescent; Amikacin; Anti-Bacterial Agents; Cefoxitin; Clarithromycin; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Mastoiditis; Mycobacterium Infections; Nontuberculous Mycobacteria; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Cefaclor; Cefixime; Cefotaxime; Cefuroxime; Cephalosporins; Child; Humans; Otitis Media; Penicillins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Administration, Oral; Adolescent; Child; Child, Preschool; Drug Combinations; Hematologic Diseases; Humans; Infant; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

Antibiotic treatment of acute otitis media (AOM) accounts for a significant number of all antibiotic prescriptions each year. In the primary care setting, initial antibiotic selection is rarely based on direct evidence, such as cultures of middle ear fluid. Initial antibiotic therapy by the primary care practitioner involves the evaluation and application of information related to prevalence of infecting organisms; in vitro antibiotic spectrum and penetration into middle ear fluid; initial cure rate, relapse and recurrence rates; and antibiotic cost, safety, and convenience. The influence of these factors on the initial antibiotic choice for AOM is reviewed. Several therapeutic dilemmas confronting the prescriber are discussed and a rational approach to initial antibiotic therapy is presented.

Topics: Acute Disease; Anti-Bacterial Agents; Drug Combinations; Humans; Otitis Media; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to test the hypothesis that trimethoprim/sulfamethoxazole selects for integron-positive and multidrug-resistant Enterobacteriaceae in the intestinal flora.. During 1 year of follow-up, antibiotic susceptibility and the presence of integrons were determined in faecal Enterobacteriaceae isolated from 99 children with chronic active otitis media, randomly assigned to treatment with trimethoprim/sulfamethoxazole or placebo (http://www.clinicaltrials.gov/; trial registration number NCT00189098).. At 6 and 12 weeks of follow-up, 32 (91%) and 24 (67%) children in the trimethoprim/sulfamethoxazole group carried trimethoprim/sulfamethoxazole-resistant Enterobacteriaceae versus 10 (21%) and 8 (17%) children in the placebo group [rate differences (RDs): 70 (95% CI: 55; 85) and 50 (95% CI: 31; 69)], respectively. Multiresistance also increased during trimethoprim/sulfamethoxazole treatment. At 6 weeks of follow-up, the integron prevalence was 26 (79%) in the trimethoprim/sulfamethoxazole group and 10 (22%) in the placebo group [RD: 57 (95% CI: 39; 75)]. After 12 weeks the integron prevalence, and after 1 year the susceptibility levels, had returned to baseline values.. Initially, trimethoprim/sulfamethoxazole usage was strongly associated with the appearance of integron-positive (multi)drug-resistant Enterobacteriaceae in the intestinal flora. After prolonged exposure to trimethoprim/sulfamethoxazole, however, this population of Enterobacteriaceae was substituted by a population with non-integron-associated resistance mechanisms. After trimethoprim/sulfamethoxazole was discontinued, susceptibility rates to all antibiotics returned to baseline levels.

Topics: Child; Child, Preschool; Double-Blind Method; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Follow-Up Studies; Gastrointestinal Tract; Humans; Infant; Integrons; Otitis Media; Prevalence; Selection, Genetic; Trimethoprim, Sulfamethoxazole Drug Combination

To study the cost-effectiveness of a 6- to 12-week course of high-dose oral trimethoprim-sulfamethoxazole in children with chronic active otitis media (COM).. Cost-effectiveness study including both direct and indirect costs alongside a randomized placebo-controlled trial.. Tertiary care university hospital in the Netherlands.. One hundred one children aged 1 to 12 years with a documented history of COM for at least 3 months.. Six to 12 weeks of oral trimethoprim-sulfamethoxazole 18 mg/kg twice daily versus placebo.. Incremental cost-effectiveness in terms of costs per number needed to treat (NNT) to cure 1 patient (incremental cost-effectiveness ratio [ICER]). Curation was defined as no otomicroscopic signs of otorrhea in either ear.. After 6 weeks of follow-up, the difference in mean cost per patient between the trimethoprim-sulfamethoxazole and placebo groups was Euro100 (US $126). The NNT was 4 (clinical effect), and the corresponding ICER was Euro400 (US $504), that is, the average extra costs to cure 1 child from otorrhea is Euro400 (US $504). After 12 weeks of follow-up, the difference in mean costs between both groups was Euro159 (US $201), the NNT was 7, and the corresponding ICER was Euro1,113 (US $1,407).The mean costs after 1 year of follow-up were Euro1,601 (US $2,021) in the trimethoprim-sulfamethoxazole group and Euro1,164 (US $1,469) in the placebo group. Because the clinical effect of trimethoprim-sulfamethoxazole disappeared after its discontinuation, we did not calculate an ICER at 1 year of follow-up.. In children with active COM, direct and indirect costs of a 6- to 12-week course of high-dose oral trimethoprim-sulfamethoxazole are modest in the light of its short-term clinical benefit.

Topics: Anti-Infective Agents; Child; Child, Preschool; Chronic Disease; Cost-Benefit Analysis; Follow-Up Studies; Hospitals, University; Humans; Infant; Netherlands; Otitis Media; Placebos; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The goal was to determine the clinical effectiveness of prolonged outpatient treatment with trimethoprim/sulfamethoxazole for children with chronic active otitis media.. We performed a randomized, placebo-controlled trial with 101 children (1-12 years of age) with chronic active otitis media (defined as otorrhea for > or =12 weeks). In addition to a short course of steroid and antibiotic eardrops, children were assigned randomly to receive 6 to 12 weeks of orally administered trimethoprim/sulfamethoxazole (18 mg/kg, 2 times per day) or placebo and were monitored for 1 year.. At 6 weeks, 28% of children in the trimethoprim/sulfamethoxazole group and 53% of children in the placebo group had otomicroscopic signs of otorrhea. At 12 weeks, these values were 32% and 47%, respectively. At 1 year, the numbers of children with otorrhea were similar in the 2 groups (25% and 20%, respectively). One child in the trimethoprim/sulfamethoxazole group developed a skin rash. Vomiting or diarrhea was reported for 9% of the trimethoprim/sulfamethoxazole group and 2% of the placebo group. Pure-tone hearing levels and health-related quality of life improved during the study but did not differ between the trimethoprim/sulfamethoxazole group and the placebo group. Pseudomonas aeruginosa was the most frequently isolated bacteria in the otorrhea samples from both groups.. A 6- to 12-week course of high-dose, orally administered trimethoprim/sulfamethoxazole therapy is beneficial for children with chronic active otitis media. The treatment effect is most pronounced with the shorter course and disappears if administration of the medication is discontinued.

Topics: Child; Child, Preschool; Chronic Disease; Female; Follow-Up Studies; Humans; Infant; Male; Otitis Media; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim sulfamethoxasole has been recommended for the treatment of acute otitis media. In this double tympanocentesis study, children aged 3 to 48 months with acute otitis media received trimethoprim sulfamethoxasole twice daily (40 mg/kg/d) for 10 days. All children had a baseline tympanocentesis and in culture-positive children, tympanocentesis was repeated at the on-therapy visit. Of 89 children enrolled, 51 (57%) were clinically and bacteriologically evaluable. Bacteriologic eradication was achieved in 80% (42 of 52) of children, and overall clinical response at the end of therapy was 78%. Clinical success was 69% for culture-positive children versus 91% for culture-negative children at baseline tympanocentesis (P = 0.03). In this study, trimethoprim sulfamethoxasole clinical response was unsatisfactory, especially among culture-'positive children.

Topics: Anti-Bacterial Agents; Humans; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

Antibiotic-resistant pneumococci are difficult to eradicate from middle ear fluid (MEF) and the nasopharynx (NP). Bacteriologic eradication from the NP and MEF during acute otitis media (AOM) by 3 common antibiotic drugs was prospectively evaluated. In 19 (16%) of 119 MEF culture-positive patients, an organism susceptible to the treatment drug (Haemophilus influenzae, Streptococcus pneumoniae, or both) was isolated from the initial MEF, whereas resistant S. pneumoniae was present in the NP; in 9 (47%) patients, the initial resistant NP organism (identified by serotyping, resistance to the administered drug, and pulsed-field gel electrophoresis) replaced the susceptible MEF organism within only a few days after initiation of treatment. In regions where resistant pneumococci are prevalent, antibiotics may not only fail to eradicate the organisms, but they may often induce MEF superinfection with resistant pneumococci initially carried in the NP. This is an important mechanism by which, in recently treated patients, AOM infections often become refractory to treatment.

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Azithromycin; Child; Drug Resistance, Microbial; Drug Therapy, Combination; Ear, Middle; Female; Humans; Male; Nasopharynx; Otitis Media; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Superinfection; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Child; Humans; Otitis Media; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

We enrolled 60 children with recurrent acute otitis media (AOM) in a study of the effectiveness of antimicrobial prophylaxis. All children were entered into the study following an acute episode of infection treated with amoxicillin (AMX) for 10 days. Following therapy, the children were re-examined, and then randomly assigned to receive either trimethoprim-sulfamethoxazole (TMP-SMX), amoxicillin (AMX) or a placebo (PLA). Twenty children were included in each group. Each drug was administered once a day at bedtime, at 1/3 the therapeutic dose, for 3 months. Children were re-evaluated with pneumootoscopy during episodes of acute illness and with pneumootoscopy and impedance tympanometry (TYMP) at monthly intervals. We observed a significantly increased rate of recurrent AOM in children receiving placebo compared with those who received antibiotics (50% vs. 17% P < 0.005). Both prophylactic antibiotics were equally effective in preventing recurrent AOM (recurrence rate 20% TMP-SMX, 15% AMX). We also observed that recurrences in children receiving placebo occurred earlier in the study period than in those receiving antibiotics. These results suggest that antimicrobial prophylaxis in children with recurrent acute otitis media is effective in reducing subsequent disease. The similar efficacy of both antibiotics tested suggests that the less expensive agent should be used.

Topics: Amoxicillin; Brazil; Child, Preschool; Female; Humans; Male; Otitis Media; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

In randomized, double-blind trials of antibiotic therapy for acute otitis media that determined both clinical and bacteriologic outcomes, clinical success rates were (93%) 236 of 253 for patients with bacteriologic success, (62%) 25 of 40 for those with bacteriologic failure, and (80%) 124 of 155 for those with nonbacterial acute otitis media. These rates were used to calculate the effectiveness of three strategies for assessing drug efficacy: (1) tympanocentesis and culture before and during therapy (bacteriologic efficacy), (2) tympanocentesis before therapy and assessment of clinical efficacy in bacterial acute otitis media, and (3) no tympanocentesis and assessment of clinical efficacy in clinical (total) acute otitis media. For a drug with a bacteriologic efficacy of 100%, calculated clinical efficacy was 93% for bacterial acute otitis media and 89% for clinical acute otitis media. For a drug with bacteriologic efficacy of 27%, a rate consistent with no antibacterial therapy, efficacy was 71% for bacterial acute otitis media and 74% for clinical acute otitis media. We conclude that if efficacy is measured by symptomatic response, drugs with excellent antibacterial activity will appear less efficacious than they really are and drugs with poor antibacterial activity will appear more efficacious than they really are. The predominant phenomenon is that drugs with poor antibacterial activity will appear to be clinically effective in the treatment of acute otitis media.

Topics: Acute Disease; Amoxicillin; Ampicillin; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Cefaclor; Cefixime; Cefotaxime; Clavulanic Acid; Clavulanic Acids; Double-Blind Method; Drug Combinations; Efficiency; Enzyme Inhibitors; Female; Haemophilus influenzae; Humans; Infant; Male; Moraxella catarrhalis; Otitis Media; Punctures; Streptococcus pneumoniae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tympanic Membrane

Twice-daily trimethoprim-sulfamethoxazole has been shown to be effective in the treatment of acute otitis media except that caused by group A beta-streptococci. Amoxicillin-clavulanate potassium is effective in vitro against all bacterial pathogens causing acute otitis media and has been reported to be effective when given twice daily for urinary tract infections, acute otitis media and respiratory tract infections. To determine whether the in-vitro efficacy of amoxicillin-clavulanate carries over clinically, we conducted a prospective randomized double-blind trial in 219 children presenting at a pediatric walk-in clinic. Diagnosis and follow-up assessments were made by means of examination of the tympanic membrane and acoustic otoscopy. Of the 219 children 202 (101 in either group) were assessed by a specially trained nurse at a follow-up visit 12 to 16 (mean 14) days after treatment was begun. Cure was defined as absence of symptoms and normal results of both visual inspection of the tympanic membrane and acoustic reflectometry; improvement was defined as absence of symptoms and either normal appearance of the tympanic membrane or normal results of acoustic reflectometry; treatment failure was defined as abnormal appearance of the tympanic membrane along with an acoustic reflectometry reading of 5 units or more. There were no differences in age (mean 60 months), sex or proportion of subjects with unilateral versus bilateral disease between the two groups. The combined rate of cure an improvement was significantly higher with trimethoprim-sulfamethoxazole (93%) than with amoxicillin-clavulanate (82%) (p = 0.03). The rate of compliance (more than 80% of the drug taken) did not differ significantly between the two groups. Gastrointestinal side effects were more common with amoxicillin-clavulanate (p less than 0.0001). Our results suggest that for acute otitis media twice-daily trimethoprim-sulfamethoxazole is more effective clinically and produces fewer side effects than twice-daily amoxicillin-clavulanate.

Topics: Acoustic Impedance Tests; Adolescent; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Child; Child, Preschool; Clavulanic Acids; Diarrhea; Double-Blind Method; Drug Administration Schedule; Drug Evaluation; Drug Therapy, Combination; Follow-Up Studies; Humans; Infant; Otitis Media; Patient Compliance; Prospective Studies; Randomized Controlled Trials as Topic; 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

The efficacy of cefaclor and of trimethoprim-sulfamethoxazole (TMP-SMX) in the management of recurrent otitis media was evaluated in a randomized single-blind controlled trial. The median age of the patients was 12 months (range 5-37); there were 37 boys and 19 girls. All had received 1 or more courses of antibacterials for acute otitis media in the previous 2-3 weeks. 27 were treated with oral cefaclor suspension, 40 mg/kg/day in 3 divided doses, and 29 with 1 mg/kg/day of TMP-SMX (trimethoprim 8 mg, sulfamethoxazole 40 mg) in 2 divided doses, each group for 10 days. 70% of the cefaclor group and 90% of the TMP-SMX group were cured after the 10 days of therapy (0.1 greater than p greater than 0.05). Results were not better on the 21st day as compared with the 10th. Our data indicate a mild preference for TMP-SMX (although p was not less than 0.05), since it needs to be given only twice a day and costs less than cefaclor.

Topics: Acute Disease; Cefaclor; Cephalexin; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Male; Otitis Media; Randomized Controlled Trials as Topic; Recurrence; Single-Blind Method; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Aged; Amdinocillin; Amdinocillin Pivoxil; Amoxicillin; Ampicillin; Drug Combinations; Female; Humans; Male; Middle Aged; Otitis Media; Pivampicillin; Random Allocation; Respiratory Tract Infections; Sinusitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We report the hematologic changes in 90 black children who were randomized to receive a 10-day course of either trimethoprim-sulfamethoxazole (TMP-SMZ) or amoxicillin as therapy for acute otitis media. Absolute neutrophil counts less than 1500/mm3 developed at least once during the 23-day evaluation in 28 (57%) of the 49 children given TMP-SMZ and in 22 (54%) of the 41 who received amoxicillin. Incidence of leukopenia, thrombocytopenia, and anemia was negligible in both groups. Pancytopenia did not occur in any child. Absolute neutrophil counts had increased to greater than 1500/mm3 by the end of the study period in all of the patients but six, whose recovery required an additional 1 to 63 days. Decreased neutrophil counts in antibiotic-treated subjects remained within the range of findings for healthy black children, suggesting that a count less than 1500/mm3 may be an inappropriate criterion for an adverse drug effect. Neither TMP-SMZ nor amoxicillin produced hematologic effects that would detract from their continued use in children with infections caused by antibiotic-susceptible organisms.

Topics: Amoxicillin; Clinical Trials as Topic; Drug Combinations; Female; Humans; Infant; Leukocyte Count; Leukopenia; Male; Neutrophils; Otitis Media; Random Allocation; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Seven-day courses of either 200 mg pivmecillinam plus 250 mg pivampicillin or co-trimoxazole (800 mg sulphamethoxazole plus 160 mg trimethoprim) given twice daily were compared in a multi-centre general practice study in 318 patients with signs and symptoms of upper or lower respiratory tract infection. Patients were stratified into four diagnostic groups (sinusitis, otitis media, throat infections, and acute bronchitis) and randomly allocated to treatment within these groups. Assessments at Day 7 showed that both treatments were equally effective clinically, 154 (91%) patients in the pivmecillinam plus pivampicillin group showing clinical cure or improvement and 142 (88%) patients in the co-trimoxazole group. Side-effects were reported by 19 (11.9%) patients in the pivmecillinam plus pivampicillin group and by 24 (15.8%) patients in the co-trimoxazole group. Two patients in the pivmecillinam plus pivampicillin group and 4 patients in the co-trimoxazole group stopped treatment.

Topics: Adolescent; Adult; Aged; Amdinocillin; Amdinocillin Pivoxil; Ampicillin; Anti-Infective Agents; Bronchitis; Child; Clinical Trials as Topic; Drug Combinations; Family Practice; Female; Humans; Male; Middle Aged; Otitis Media; Pharyngitis; Pivampicillin; Random Allocation; Respiratory Tract Infections; Sinusitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We performed a randomized controlled trial of cefaclor administered twice daily compared with trimethoprim-sulfamethoxazole (TMP-SMZ) administered twice daily for the treatment of acute otitis media. Pathogens were eradicated from the middle ear exudate after 3 to 6 days of therapy in 35 of 37 (95%) patients given TMP-SMZ compared with 28 of 40 (70%) given cefaclor (P = 0.017). Haemophilus influenzae was eliminated in 13 of 14 (93%) patients given TMP-SMZ compared with 10 of 18 (56%) given cefaclor (P = 0.047). Clinical outcomes failed to distinguish between patients given TMP-SMZ or cefaclor. Symptoms improved despite persistent infection in 11 of 13 (85%) patients; middle-ear effusion persisted after therapy in 38 of 61 (62%) patients despite eradication of pathogens. We conclude that twice daily TMP-SMZ is more efficacious than twice daily cefaclor for the treatment of acute otitis media and that clinical outcomes may fail to detect differences between antibacterial agents in comparative drug trials in acute otitis media.

Topics: Acute Disease; Cefaclor; Cephalexin; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Female; Humans; Infant; Male; Otitis Media; Random Allocation; 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

The tolerabilities of ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole (TMP-SMX) suspensions were evaluated in 263 children with otitis media. Because of watery stools, therapy was discontinued in 6 of 83 patients treated with ampicillin, in none of 89 patients treated with amoxicillin (P less than 0.01), and in 1 of 91 patients treated with TMP-SMX (P less than 0.03). Of the patients who completed the treatment courses, 13 recipients of ampicillin suffered loose or watery stools for 4 or more days, compared with 6 of the amoxicillin recipients (P less than 0.04) and 5 of the TMP-SMX recipients (P less than 0.02). Thus, ampicillin was clearly less well tolerated than either amoxicillin or TMP-SMX.

Topics: Amoxicillin; Ampicillin; Child; Child, Preschool; Drug Combinations; Humans; Infant; Otitis Media; Sulfamethoxazole; Suspensions; 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

Pseudoclavibacter has rarely been documented as an etiologic agent of infection in humans. We presented the first case report of Pseudoclavibacter otitis media in a boy with pulmonary and spinal tuberculosis.A 3-year-old boy was referred to our hospital due to prolonged fever and progressive paraplegia for 3 months. He had yellowish discharge from both ear canals. The pleural fluid culture was positive for Mycobacterium tuberculosis. The discharge from both ears culture yielded yellow colonies of gram-positive bacilli with branching. This organism was positive for modified acid-fast bacilli stain but negative for acid-fast bacilli stain. Biochemical characteristics of this isolate were positive for catalase test but negative for oxidase, nitrate, esculin, and sugar utilization tests. The organism was further subjected to be identified by 16S ribosomal deoxyribonucleic acid gene sequencing. The result yielded Pseudoclavibacter species (99.4% identical), which could be most likely a potential pathogen in immunocompromised host like this patient. He responded well with intravenous trimetroprim-sulfamethoxazole for 6 weeks.This is the first case report of Pseudoclavibacter otitis media in children, and this case could emphasize Pseudoclavibacter species as a potential pathogen in immunocompromised host.

Topics: Actinomycetales; Actinomycetales Infections; Child, Preschool; Humans; Male; Mycobacterium tuberculosis; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary; Tuberculosis, Spinal

Here, we report a case of tetanus who presented with five months of symptoms and signs suggesting the presence of unusual presentation of tetanus so called chronic tetanus. The available literature on this a typical presentation and difficulty in the diagnosis is briefly discussed.

Topics: Adult; Anti-Infective Agents; Anticonvulsants; Chlorpromazine; Chronic Disease; Diagnosis, Differential; Diazepam; Humans; Male; Otitis Media; Tetanus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

AIDS-associated otic pneumocystosis is rare. Of 14 cases documented mainly as case reports up to now, only 1 has been reported in the surgical pathology literature. We report 6 males, mean age of 32.3 years, with external auditory canal masses and otorrhea. Two biopsies contained a predominance of granulation tissue with a mixed inflammatory cell infiltrate and elusive foci of foamy exudate. In contrast, 4 biopsies demonstrated conspicuous angiocentric mantles of stippled, foamy exudate. Fibrin was noted in intravascular, perivascular, and intervascular locations. One biopsy demonstrated bordering of the foamy exudate by a palisaded granulomatous reaction, with adjacent discrete giant cell-containing granulomas. Special stains confirmed trophozoites and cysts within the foamy exudate. Review of 2 initial "nondiagnostic" biopsies confirmed granulation tissue and necrotic debris in which Pneumocystis jiroveci was identified in focal foamy exudate. After the diagnosis of otic pneumocystosis, all patients were initiated on trimethoprim-sulfamethoxazole. One patient also had dapsone. Two patients succumbed to pulmonary tuberculosis and 2 were lost to follow-up. One patient with pneumocystis pneumonia did not return for follow-up after 6 weeks. One patient experienced complete resolution of the mass on medical therapy, and is disease free for 4 years. Heightened recognition of the characteristic foamy exudate in an unconventional location remains the gold standard in the timely diagnosis of this eminently treatable disease. In all patients, otic pneumocystosis served as the sentinel of underlying HIV infection and AIDS.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Dapsone; Drug Therapy, Combination; Fatal Outcome; Humans; Immunocompromised Host; Male; Otitis Media; Pneumocystis Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Child; Chronic Disease; Humans; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

To report our experience in identification and treatment of acute otitis media (AOM) with otorrhea secondary to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), which is seen in children at increasing rates.. Clinical and laboratory records were retrospectively reviewed between January 2003 and December 2003.. Primary pediatric clinic.. Six pediatric patients who had AOM with otorrhea caused by CA-MRSA.. Clinical resolution of AOM with otorrhea.. All patients had acute-onset otorrhea associated with their AOM. Five patients had tympanostomy tubes and 1 had perforation of the tympanic membrane. None of the patients were responding to treatment with oral antibiotics (amoxicillin sodium-clavulanate potassium, cefpodoxime proxetil, and cefprozil) or fluoroquinolone ear drops (ofloxacin, ciprofloxacin). Specimens were obtained from the ears for cultures, and MRSA was present in the cultures. The organisms were resistant to levofloxacin and erythromycin in all patients and resistant to clindamycin hydrochloride in 2 patients. The cultures were sensitive to trimethoprim-sulfamethoxazole, gentamicin sulfate, rifampin, and vancomycin hydrochloride. All patients were treated successfully with oral trimethoprim-sulfamethoxazole and ear drops (gentamicin sulfate or polymyxin B sulfate-neomycin sulfate-hydrocortisone [Cortisporin]).. The rising rate of CA-MRSA as a cause for many pediatric infections is a major concern. It is very important to obtain cultures from patients with nonresponsive or persistent otorrhea with AOM to look for MRSA and determine the sensitivity of the pathogen to antibacterial therapy. Trimethoprim-sulfamethoxazole is a good choice for initial, empirical therapy when combined with a topical agent for AOM with otorrhea if CA-MRSA is suspected. Further studies are needed to determine whether there is a link between the overuse of topical fluoroquinolones in pediatric patients and the recent rising rate of CA-MRSA.

Topics: Acute Disease; Administration, Topical; Anti-Infective Agents; Child; Child, Preschool; Community-Acquired Infections; Female; Humans; Infant; Male; Methicillin Resistance; Middle Ear Ventilation; Otitis Media; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis occurs primarily as an opportunistic infection in an immunocompromised host. The infection may on rare occasion occur in a normal host confounding the diagnosis. It is also notably an uncommon infection in children. We report a 1-y-old girl with cervicofacial nocardial infection who presented with acute suppurative otitis media and lymphadenitis. This child did not have any predisposing risk factors for this infection and responded well to treatment with co-trimoxazole and chloramphenicol. She is doing well on follow-up.. Nocardiosis in an immunocompetent small child is reported.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Chloramphenicol; Drug Therapy, Combination; Face; Female; Humans; Immunocompetence; Infant; Lymphadenitis; Neck; Nocardia; Nocardia Infections; Otitis Media; Skin Diseases, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the current management of acute otitis media by New Zealand general practitioners (GPs).. A reply-paid questionnaire was sent to 2000 New Zealand GPs. The questions relate to management of a three year old child presenting with her first episode of acute otitis media.. 95% of respondents reported they would usually or always use antibiotics. Amoxicillin was the antibiotic of choice, followed by amoxicillin/clavulanate. Cotrimoxazole was the antibiotic of choice in the case of allergy to amoxicillin. 82% of respondents recommended follow-up, with a broad range of follow-up times (24 hours to 12 weeks). Approximately half of practitioners considered 5-6 episodes of acute otitis media in a year as an appropriate threshold for referral for grommets. Most GPs had received an update on otitis media within the previous two years.. There is considerable variation in the management of acute otitis media by New Zealand GPs. Use of a national guideline may result in a more standardised, rational approach to the treatment of acute otitis media.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Child, Preschool; Drug Therapy, Combination; Humans; New Zealand; Otitis Media; Penicillins; Physicians, Family; Practice Patterns, Physicians'; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (T/S) has often been used as first and second line of treatment for acute otitis media (AOM). Because of the increasing resistance of Streptococcus pneumoniae and Haemophilus influenzae to T/S, we undertook the present study to investigate the bacteriologic and clinical efficacy of this drug in AOM.. Fifty-four culture-positive evaluable patients ages 3 to 32 months with AOM were treated with T/S 4/20 mg/kg in two divided daily doses for 10 days. Middle ear fluid (MEF) was cultured at enrollment (Day 1) and on Days 4 and 5 after initiation of treatment. Additional MEF cultures were obtained if clinical relapse occurred. Clinical failure was determined when the symptoms and signs of AOM did not improve or recurred during therapy. Bacteriologic failure was defined by positive culture on Days 4 and 5, or negative on Days 4 and 5 but positive again before the end of treatment. Patients were followed until Day 28 +/- 2.. A total of 67 organisms were isolated from MEF specimens of the 54 study patients: S. pneumoniae, 24; H. influenzae, 40; and Streptococcus pyogenes, 3. Fifteen (63%) of 24 S. pneumoniae were nonsusceptible to T/S (trimethoprim MIC, >0.5 microg/ml), of which 10 (67%) were highly resistant to T/S (trimethoprim MIC, > or = 4.0 microg/ml). Twelve (30%) of 40 H. influenzae and all 3 S. pyogenes isolates were nonsusceptible to T/S (MIC > or = 4.0 microg/ml). Bacteriologic eradication occurred in 9 of 9 (100%) and 27 of 27 (100%) T/S-susceptible S. pneumoniae and H. influenzae, respectively, vs. 4 of 15 (27%) and 6 of 12 (50%) T/S-nonsusceptible S. pneumoniae and H. influenzae, respectively (P < 0.001). The 3 patients with S. pyogenes failed bacteriologically. Nine new organisms, not initially isolated, emerged during treatment, 7 of which (77%) were resistant to T/S. Altogether bacteriologic failure (organisms not eradicated plus newly emerged) occurred in 29 (53%) of 54 patients. Clinical failures occurred in 8 (15%) of 54 patients, and in 7 of these 8 cases the clinical failures occurred in those with bacteriologic failures. Ten patients relapsed clinically after completion of treatment and in 8 of them tympanocentesis for MEF culture was performed. Six of these 8 cultures were positive, and the initial pathogen was isolated in 4 of 6 (67%).. A high bacteriologic failure rate as well as a considerable clinical failure rate occurred among patients with AOM treated with T/S. We believe that T/S is no longer an appropriate empiric choice for the treatment of AOM in regions where high T/S resistance among respiratory pathogens is reported.

Topics: Acute Disease; Anti-Bacterial Agents; Child, Preschool; Drug Resistance, Bacterial; Female; Haemophilus influenzae; Humans; Infant; Male; Microbial Sensitivity Tests; Otitis Media; Streptococcus pneumoniae; Treatment Failure; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; Foreign Bodies; Humans; Infant; Laryngoscopy; Larynx; Otitis Media; Syringes; Trimethoprim, Sulfamethoxazole Drug Combination

Otitis media occurs commonly in children, and is usually treated with an antibiotic. In this case report, amoxicillin was prescribed for a 6-year-old boy suffering from acute otitis media. As he had previously experienced a rash after the administration of a penicillin, the medication order was switched from amoxicillin to trimethoprim/sulfamethoxazole (TMP/SMX). In an effort to determine whether or not this intervention was appropriate, references were found using Medline, International Pharmaceutical Abstracts and the Cochrane Library. Issues to be addressed included the need for antibiotics in acute otitis media, the comparative efficacy and tolerability of antimicrobial agents and the reliability of reported penicillin allergies. Amoxicillin and TMP/SMX were found to be first-line agents in the treatment of acute otitis media owing to their efficacy, safety and cost, with neither drug being significantly better than the other. The need to treat otitis media with antibiotics remains controversial. Reported penicillin allergies were found to be an unreliable indicator of a potentially serious reaction. In conclusion, it was found that treatment with TMP/SMX was an appropriate intervention.

Topics: Acute Disease; Anti-Infective Agents; Child; Databases, Factual; Drug Eruptions; Humans; Male; Otitis Media; Penicillins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Complications of otitis media are relatively infrequent, especially since the introduction of effective antimicrobial agents and specific surgical techniques. We present a case of cerebral pseudotumor due to left sigmoid sinus thrombosis as an intracranial complication of otitis media. We review the various clinical manifestations of sigmoid sinus thrombosis and its therapeutic options.

Topics: Acetazolamide; Acetone; Anti-Infective Agents; Anticonvulsants; Child, Preschool; Female; Follow-Up Studies; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Otitis Media; Pseudotumor Cerebri; Sinus Thrombosis, Intracranial; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Recurrent infection after an episode of otitis media is common in pediatric patients. If a patient experienced primary treatment failure in a preceding episode, physicians often feel pressured to prescribe a broad-spectrum, second-line agent for the next episode rather than a first-line drug. The purpose of our study was to determine whether using a second-line drug resulted in fewer treatment failures in a recurrent otitis episode following an episode of apparent resistance.. The Practice Partner Research Network database, a national research network of practices that use the same electronic medical record, was reviewed to identify all primary episodes of otitis media over a 2-year period (N = 7807). From this, 1416 pediatric patients with presumed treatment failures were identified. The subset of those with a second otitis media episode more than 90 days after the index episode (N = 343) was selected for study. Of this group, 236 (69%) received first-line antibiotics (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) and the remaining 107 received a broader-spectrum, second-line antibiotic. The primary outcome was the need for an additional antibiotic for otitis media within the next 45 days.. Patients receiving first- and second-line antibiotics did not differ in sex or age. However, those receiving second-line antibiotics had a shorter duration between episodes (231 vs 280 days, P = .007). Failure rates for first- and second-line antibiotics in recurrent episodes were not significantly different (13% vs 19%, P = .20). Because the duration between episodes could have affected failure rates, we stratified the time between episodes into short, intermediate, and long duration. Second-line antibiotics were not superior to first-line drugs in any stratum.. For a new otitis media episode in a patient with a previous treatment failure, first-line drugs (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) are just as effective as broader-spectrum, more expensive, second-line antibiotics.

Topics: Acute Disease; Anti-Bacterial Agents; Anti-Infective Agents; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Male; Otitis Media; Penicillins; Recurrence; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Audiometry; Bone Conduction; Cefuroxime; Cephalosporins; Ciprofloxacin; Drug Therapy, Combination; Facial Paralysis; Female; Follow-Up Studies; Glucocorticoids; Hearing Loss; Hearing Loss, Conductive; Humans; Male; Middle Aged; Otitis Media; Penicillins; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination; Tympanic Membrane

During 1995 and 1996, 393 and 566 strains of Streptococcus pneumoniae, isolated from acute otitis media, were respectively sent to the National Reference Center for Pneumococci by its corresponding centers.. The resistance rates for 1995 and 1996 were respectively: for penicillin: 65.4 and 70.3% (18.6 and 24.9% of intermediately resistant strains, 46.8 and 45.4% of fully resistant strains), for erythromycin: 57.5 and 68.5%, for tetracycline: 43.2 and 42.6%, for trimethoprim-sulfamethoxazole: 47.5 and 50.9%. Minimal inhibitory concentrations (MICs) of various betalactams were determined against a representative sample of strains (n = 99).. Amoxicillin, cefpodoxime and cefuroxime MICs remained low against numerous penicillin resistant strains, indicating that these three oral antibiotics (in combination with clavulanate for amoxicillin) have a useful potential for the treatment of acute otitis media when risk factors for pneumococcal penicillin-resistant infections are detected.

Topics: Acute Disease; Amoxicillin; beta-Lactam Resistance; beta-Lactams; Cefpodoxime; Ceftizoxime; Cefuroxime; Erythromycin; France; Humans; Microbial Sensitivity Tests; Otitis Media; Penicillin Resistance; Penicillins; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Acute otitis media is the most common bacterial infection in the child under 5 years of age and the leading reason for antibiotic prescriptions in Western countries. The choice of optimal antibiotic treatment is based essentially on microbiologic epidemiologic studies. The bacteria most often responsible for otitis belong to the commensal flora of the nasopharynx. French studies using paracentesis show that the main bacteria responsible for acute otitis media are H. influenzae, S. pneumoniae and M. catarrhalis. The epidemiology of resistance to antibiotics has recently changed, with the appearance of pneumococcal strains having reduced sensitivity to penicillin, and which have played a major role in treatment failures.

Topics: Acute Disease; Age Factors; Anti-Bacterial Agents; Child, Preschool; Drug Resistance, Bacterial; Erythromycin; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Moraxella catarrhalis; Nasopharynx; Otitis Media; Penicillin G; Penicillin Resistance; Penicillins; Seasons; Staphylococcus aureus; Streptococcus pneumoniae; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination

Treatment of otitis media is the most frequent reason for administering antibiotics to children in the United States. However, only limited data are available on medical effectiveness of antibiotic prescribing patterns for otitis media and their associated expenditures or the factors that influence antibiotic prescribing.. The study population consisted of 131 169 children during 1991 and 157 065 children during 1992 who were

Topics: Acute Disease; Adolescent; Amoxicillin; Anti-Bacterial Agents; Cephalosporins; Child; Child, Preschool; Cohort Studies; Colorado; Drug Combinations; Drug Costs; Drug Utilization; Erythromycin; Female; Humans; Infant; Male; Medicaid; Otitis Media; Practice Patterns, Physicians'; Sulfisoxazole; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Topics: Acute Disease; Anti-Infective Agents; Child; Cost-Benefit Analysis; Health Maintenance Organizations; Humans; Otitis Media; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Acute otitis media, a common childhood disorder, is an inflammation of the middle ear. It is the most frequent diagnosis made in primary care settings for children under 15 years of age. Almost all children are afflicted with at least one episode of otitis media before age 6. Diagnosis can often be challenging, especially in infants and toddlers. Moreover, management controversies exist. This article addresses the epidemiology, clinical presentation, and diagnosis of acute otitis media and presents treatment options based on results of recent research. When a child is diagnosed with acute otitis media, it behooves the clinician to use sound research-based clinical judgment in prescribing treatment.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Anti-Infective Agents; Child; Child, Preschool; Drug Therapy, Combination; Humans; Infant; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Palatability of oral antibiotic suspensions is important and may be a substantial factor in determining compliance in young pediatric patients. Because no comparative systematic data are available, we undertook the present study to assess the acceptance of and compliance with oral antibiotic suspensions commonly used in Israel. During a 4-month period lists of children receiving oral antibiotic suspensions were obtained from 3 major pediatric clinics, and parents were contacted by telephone 10 to 14 days after initiation of therapy, at which time information on age, sex, main disease, prescribed drugs and duration of treatment was obtained. Information regarding acceptance, side effects and compliance was obtained from 11 questions with graded scores. In the study 546 children received one of the following drugs: amoxicillin (n = 222); cefaclor (n - 142); cefuroxime axetil (n = 107); trimethoprim/sulfamethoxazole (n = 75). No major differences in background data were noted; more than 50% of each group had acute otitis media. Seventy-three percent of the cefaclor group reported acceptance of the drug with "pleasure" or "without problems" vs. 60, 55 and 20% for amoxicillin, trimethoprim/sulfamethoxazole and cefuroxime axetil, respectively, whereas "resentment" or "refusal" was reported in 11, 16, 26 and 56%, respectively (P < 0.0001). Mothers reported to be generally "satisfied" or "extremely satisfied" with the drug in 89, 81, 74 and 67% with cefaclor, amoxicillin, trimethoprim/sulfamethoxazole and cefuroxime axetil, respectively, and 85, 77, 73 and 67% of the children, respectively, received the drug for the entire prescribed course (P < 0.001). Our data demonstrate that marked variations exist in acceptance and compliance of oral antibiotic suspensions with children.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Cefaclor; Cefuroxime; Child, Preschool; Female; Humans; Infant; Israel; Male; Otitis Media; Patient Compliance; Surveys and Questionnaires; Suspensions; Taste; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Child; Humans; Otitis Media; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

The periurethral flora was examined in 18 girls by use of a quantitative sampling method before, during, and three weeks after treatment with antibiotics for upper respiratory tract infections. Eight girls received amoxicillin. In five of them the anaerobic flora showed a reduction in total counts and in numbers of different species, and all eight girls got a heavy colonisation with enterobacteria during treatment. Three weeks after treatment the anaerobic and aerobic flora had reversed to the pretreatment composition. In 10 girls treated with trimethoprim-sulphamethoxazole the anaerobic flora remained unaffected and no enterobacterial overgrowth was registered during the study period. We propose that antibiotics could be one among several factors involved in the pathogenesis of urinary tract infection, by suppression of the anaerobic microflora and promotion of the colonisation with enterobacteria.

Topics: Adolescent; Amoxicillin; Child; Child, Preschool; Colony Count, Microbial; Enterobacteriaceae; Female; Gram-Negative Aerobic Bacteria; Humans; Otitis Media; Respiratory Tract Infections; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urinary Tract Infections

The computerized outpatient records of the Harvard Community Health Plan, a 230,000-member health maintenance organization, were used to determine the frequency with which serum sickness is recognized in the practice setting after exposure to antibiotics. The medical records of 3,487 children who had been prescribed cefaclor or amoxicillin were searched in December 1986 for coded diagnoses of serum sickness and related conditions. Diagnoses were validated by blinded review of dictated and written office notes. There were 12 cases of serum sickness in 11,523 child-years. During this time, these children were prescribed 13,487 courses of amoxicillin, 5,597 courses of trimethoprim-sulfamethoxazole (TMP-SMZ), 3,553 courses of cefaclor, and 2,325 courses of penicillin V. Serum sickness was considered to be antibiotic-related if it occurred within 20 days of initiation of antibiotic therapy. Five cases were temporally associated with cefaclor, one with both amoxicillin and TMP-SMZ, four with TMP-SMZ alone, and one with penicillin V alone. One case was not associated with any antibiotic exposure. All antibiotic-related cases occurred in children under age 6 years who were treated for otitis media or streptococcal pharyngitis, and most cases began 7-11 days after initiation of antibiotic. All but one of the antibiotic-related cases occurred in children who had relatively heavy lifetime antibiotic exposure. The risk of serum sickness was significantly elevated after cefaclor compared with amoxicillin, even among the most heavily exposed children (relative risk = 14.8, p = 0.01, 95% confidence interval 2.0-352.0). Most cases prompted several physician visits, but none required hospitalization.

Topics: Adolescent; Amoxicillin; Cefaclor; Cephalexin; Child; Child, Preschool; Female; Health Maintenance Organizations; Humans; Incidence; Infant; Infant, Newborn; Information Systems; Male; Massachusetts; Otitis Media; Penicillin V; Pharyngitis; Seasons; Serum Sickness; Streptococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A variety of skin reactions have been associated with the use of sulfonamides. Most of the reactions are uneventful and abate with drug discontinuation. Rare but severe skin reactions can occur and include the Stevens-Johnson syndrome and exfoliative dermatitis. Dermal reactions appear to be the most commonly reported adverse effect in children. Drug continuance following the development of a mild skin rash may be associated with the development of a more severe dermal reaction. This report summarizes a case involving a six-year-old white girl who developed exfoliative dermatitis confined to the feet following a course of oral trimethoprim/sulfamethoxazole (TMP/SMX) for otitis media. Exfoliation is an uncommon cutaneous manifestation following sulfonamide use. Although usually a generalized process, it is unusual to find it confined to the feet. Unfortunately there is no useful diagnostic method that could specifically elucidate the cause of a dermatologic eruption. Available evidence suggest that TMP/SMX was the probable cause of our patient's rash. Adjunctive antihistamines and corticosteroids are often useful when pruritus is present. Severe reactions require vigorous supportive treatment.

Topics: Child; Dermatitis, Exfoliative; Female; Humans; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

A child was evaluated for growth failure at the University of California, San Diego. On two occasions the patient had renal bicarbonate wasting, acidosis, and growth failure associated with trimethoprim/sulfamethoxazole (TMP/SMZ) administration. On both occasions, the acidosis resolved and the growth rate normalized following a period without receiving TMP/SMZ. Renal tubular acidosis and growth failure may occur as a result of TMP/SMZ therapy in children.

Topics: Acidosis, Renal Tubular; Female; Growth Disorders; Humans; Infant; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Child; Cost-Benefit Analysis; Drug Combinations; Humans; Otitis Media; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Cefaclor; Colistin; Drug Combinations; Drug Resistance, Microbial; Humans; Infant; Male; Microbial Sensitivity Tests; Otitis Media; Sulfamethoxazole; Trimethoprim; 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

Since 1980, we have observed an increased incidence of otitis media caused by Branhamella catarrhalis. The outcome of therapy of acute otitis media caused by this organism has been studied in a number of randomised clinical trials. 75% of isolates produced beta-lactamase. Failure to sterilise B. catarrhalis-infected middle ear exudates occurred in 3 of 11 patients treated with amoxycillin or bacampicillin, 2 of 19 treated with cefaclor, but in no patients treated with co-trimoxazole (n = 10) or amoxycillin-clavulanic acid (Augmentin), [n = 9]. All treatment failures were associated with beta-lactamase-producing strains of B. catarrhalis. The emergence of antibiotic-resistant strains of B. catarrhalis in acute otitis media indicates the need for a re-evaluation of initial antibiotic therapy of this infection. This may be particularly true for areas where there is a high incidence of strains which elaborate beta-lactamase.

Topics: Amoxicillin; Clavulanic Acid; Clavulanic Acids; Drug Combinations; Humans; Neisseriaceae; Otitis Media; Penicillin Resistance; 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

The incidence of hematologic abnormalities was evaluated in 120 children with otitis media treated respectively with cotrimoxazole (trimethoprim-sulfamethoxazole) (group 1), cotrimoxazole plus folinic acid (group 2) and amoxicillin (group 3) in therapeutic doses for ten days. Only eosinophilia (an absolute count greater than or equal to 0.5 X 10(9)/l) (group 1 = 10%, 2 = 5%, 3 = 7.5%) and neutropenia (polymorphonuclear neutrophilic leucocyte count less than or equal to 1.5 X 10(9)/l) (group 1 = 35%, 2 = 17.5%, 3 = 13.3%) were noted. Early neutropenia (evident on the 5th day of therapy) occurred in all the treatment groups, thus it is not related to cotrimoxazole administration and in most cases neutrophil count reversed to normal in few days without drug discontinuation. Late neutropenia (evident after 10 days of treatment) appeared only in cotrimoxazole treated children (p less than 0.05). No superimposed bacterial infection was demonstrated in any case. Late neutropenia seems to be strictly related to the sequential blockage of folinic acid metabolism and can be prevented by the concomitant administration of folinic acid.

Topics: Agranulocytosis; Amoxicillin; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Eosinophilia; Female; Folic Acid; Humans; Infant; Male; Neutropenia; Otitis Media; Risk; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Drug Combinations; Drug Evaluation; Female; Humans; Male; Middle Aged; Otitis Media; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The increasing incidence of Haemophilus influenzae resistant to ampicillin has clinical implications not only for pediatricians but also for family physicians, because the bacterium is recognized more frequently as the etiologic agent for diseases in adults as well as in young children. Ampicillin is no longer the automatic choice for treatment of patients thought to have life-threatening H influenzae disease, and empiric treatment of otitis media must be reexamined. Chloramphenicol, as well as ampicillin, must be considered for the treatment of meningitis and other serious systemic H influenzae infections. Once the infective organism has been isolated and tested for resistance, ampicillin alone may be used if indicated or desired. Alternatives to ampicillin for middle ear infection are trimethoprim-sulfamethoxazole (Bactrim, Septra), erythromycin-sulfonamide (Pediazole), and cefaclor (Ceclor). Isolation and susceptibility tests are seldom done because they necessitate tympanocentesis.

Topics: Adult; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Child; Chloramphenicol; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Meningitis, Haemophilus; Otitis Media; Penicillin Resistance; Pneumonia; Respiratory Tract Infections; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents, Urinary; Bacterial Infections; Drug Combinations; Dysentery, Bacillary; Humans; Otitis Media; Pneumonia, Pneumocystis; Salmonella Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Administration, Oral; Adult; Bacteria; Child; Drug Combinations; Drug Interactions; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Infusions, Parenteral; Neutropenia; Nocardia Infections; Otitis Media; Pneumonia, Pneumocystis; Salmonella Infections; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections