title: Trimethoprim-sulfamethoxazole plus topical antibiotics as therapy for acute otitis media with otorrhea caused by community-acquired methicillin-resistant Staphylococcus aureus in children.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Clinical and laboratory records were retrospectively reviewed between January 2003 and December 2003.
  
  
  METHODS
  Primary pediatric clinic.
  
  
  METHODS
  Six pediatric patients who had AOM with otorrhea caused by CA-MRSA.
  
  
  METHODS
  Clinical resolution of AOM with otorrhea.
  
  
  RESULTS
  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]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Ottumwa Regional Health Center, IA 52501, USA. balshawwa@hotmail.com
authors.forename: Baha A
authors.initials: BA
authors.lastname: Al-Shawwa
authors.forename: Dennis
authors.initials: D
authors.lastname: Wegner
mesh_terms: D000208:Acute Disease; D000287:Administration, Topical; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016106:Methicillin Resistance; D008876:Middle Ear Ventilation; D010033:Otitis Media / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination