Ecological effects on the oro- and nasopharyngeal microflora in children after treatment of acute otitis media with cefuroxime axetil or amoxycillin-clavulanate as suspensions.
OBJECTIVE
To evaluate if the extent of normal microflora disturbances differed between treatment with amoxycillin-clavulanate administered in an active form and cefuroxime axetil administered as an inactive prodrug.


METHODS
Twenty-eight children, 0.5-5 years old, diagnosed with acute otitis media (AOM), were treated with either amoxycillin-clavulanate (13.3 mg/kg 3 times daily) or cefuroxime axetil (15 mg/kg twice daily) for 7 days. Saliva samples and nasopharyngeal swabs were collected before, directly after and 2 weeks after treatment. The saliva samples were quantitatively and qualitatively analyzed and the nasopharyngeal swabs were qualitatively analyzed. All isolated strains were tested for beta-lactamase production.


RESULTS
Both treatment regimens gave rise to similar alterations of the normal oropharyngeal microflora. In both groups, the amount of Streptococcus salivarius was significantly reduced (P < 0.05). The most common causative pathogens of acute otitis were S. pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. On the day of enrollment, approximately half of the patients, in both groups, were infected with more than one pathogen. The rate of infection or colonization with more than one potential pathogen was low on day 7 but recurred 2 weeks after treatment to similar levels as on day 0. The total number of patients with reinfection, recolonization or recurrence of pathogens on day 21 was 11/12 in the amoxycillin-clavulanate group and 4/7 in the cefuroxime axetil group. The most common beta-lactamase producer was M. catarrhalis.


CONCLUSIONS
The local high concentration of antibiotics in the oropharynx immediately after intake of antibiotic suspensions seem to have little or no impact on the extent of disturbance of the microflora in this region. Children of this age group seem prone to either reinfection, recolonization or persistence of pathogens within 2 weeks after treatment. Furthermore, co-infection with more than one pathogen seems common in children with AOM and infection with beta-lactamase producing microorganisms occurs frequently.
Lund
B
B
Huddinge University Hospital, Karolinska Institutet, Södertörns högskola, University College, Dalens Sjukhus and Farsta Medical Consulting, Stockholm, Sweden.
Edlund
C
C
Rynnel-Dagöö
B
B
Lundgren
Y
Y
Sterner
J
J
Nord
C E
CE
D000208:Acute Disease; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000009:adverse effects / Q000627:therapeutic use*; D002444:Cefuroxime / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*; D002511:Cephalosporins / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D015169:Colony Count, Microbial; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D010033:Otitis Media / Q000188:drug therapy* / Q000382:microbiology; D011355:Prodrugs / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D012463:Saliva / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis
D002511:Cephalosporins; D011355:Prodrugs; D019980:Amoxicillin-Potassium Clavulanate Combination; D001618:beta-Lactamases; D002444:Cefuroxime; C040738:cefuroxime axetil