[Antibiotic management of acute otitis media. New recommendations].
FAILURES OF ANTIBIOTIC TREATMENT: The number of failures after treatment of acute middle ear infections with the 2 main antibiotics prescribed (amoxicillin and the combination amoxicillin-clavulanic acid) is on the rise. These failures appear to be related to increased resistance of the 2 principal pathogens, pneumococci and Hemophilus influenzae. A NEW FORMULATION: In order to reduce the rate of failure, it has been necessary to both increase the dose of penicillin to overcome the reduced susceptibility of pneumococci to penicillin and to prescribe a beta-lactam because of the frequent isolation of beta-lactamase producing Hemophilus influenzae. A new formulation has been developed where the amoxicillin-clavulanic acid dose is 14 to 1. This allows a daily dose of 80 mg/kg for amoxicillin and 6.4 mg/kg for clavulanic acid. In one open multicentric study including 51 pediatric patients aged 3 to 48 months with acute middle ear infections, it was demonstrated that this new formulation can be very effective in eradicating the causal agents of acute middle ear infections, including pneumococci and penicillin-resistant Hemophilus. RECOMMENDATIONS FOR GOOD EFFICACY: Amoxicillin must always be prescribed, either alone or in combination with clavulanic acid, at the dose of 45 to 50 mg/kg b.i.d. the amoxicillin-clavulanic acid combination should be preferred for children under 2 years due to the risk of beta-lactamase producing Hemophilus.
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Service des Maladies infectieuses et tropicales (Pr J.L. Vildé), Hôpital Bichat-Claude Bernard, 48, rue Henri Huchard, F 75018 Paris.
D019980:Amoxicillin-Potassium Clavulanate Combination / Q000737:chemistry / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical; D004359:Drug Therapy, Combination / Q000737:chemistry / Q000627:therapeutic use*; D006192:Haemophilus Infections / Q000188:drug therapy*; D006193:Haemophilus influenzae; D006801:Humans; D010033:Otitis Media / Q000188:drug therapy* / Q000382:microbiology; D010403:Penicillin Resistance; D013296:Streptococcus pneumoniae / Q000187:drug effects
D019980:Amoxicillin-Potassium Clavulanate Combination