title: Bacteriologic response to oral cephalosporins: are established susceptibility breakpoints appropriate in the case of acute otitis media?
abstract: Bacteriologic response to cefuroxime axetil and cefaclor administered for 10 days was evaluated in acute otitis media (AOM) in patients aged 6-36 months. Middle ear fluid culture was obtained by tympanocentesis before treatment, on day 4 or 5 after initiation of treatment, and if clinical relapse occurred before day 17. Bacteriologic failure was observed in 32% of patients receiving cefaclor versus 15% of patients receiving cefuroxime axetil (P = .009). Failure rates increased with increasing MIC: For Streptococcus pneumoniae, 0.5 microg/mL (established as cutoff value for cefuroxime by the National Committee for Clinical Laboratory Standards [NCCLS]) discriminated between success and failure. For Haemophilus influenzae, high failure rates were observed for cefaclor, even with low MICs (< or = 1.0 microg/mL), and with both drugs they tended to increase with increasing MIC, even for values below the cutoff suggested by the NCCLS (8.0 and 4.0 microg/mL for cefaclor and cefuroxime, respectively). Thus, for AOM caused by H. influenzae, lower susceptibility cutoff levels for MICs should be established.
authors.affiliation: Department of Otolaryngology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Dagan
authors.forename: O
authors.initials: O
authors.lastname: Abramson
authors.forename: E
authors.initials: E
authors.lastname: Leibovitz
authors.forename: D
authors.initials: D
authors.lastname: Greenberg
authors.forename: R
authors.initials: R
authors.lastname: Lang
authors.forename: S
authors.initials: S
authors.lastname: Goshen
authors.forename: P
authors.initials: P
authors.lastname: Yagupsky
authors.forename: A
authors.initials: A
authors.lastname: Leiberman
authors.forename: D M
authors.initials: DM
authors.lastname: Fliss
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D002433:Cefaclor / Q000627:therapeutic use; D002444:Cefuroxime / Q000031:analogs & derivatives / Q000627:therapeutic use; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006193:Haemophilus influenzae / Q000187:drug effects*; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D010033:Otitis Media / Q000188:drug therapy* / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D002511:Cephalosporins; D002433:Cefaclor; D002444:Cefuroxime; C040738:cefuroxime axetil