title: Comparative effects of single-dose ceftriaxone versus three oral antibiotic regimens on stool colonization by resistant bacilli in children.
abstract: OBJECTIVE
  The use of short-term intramuscular ceftriaxone for pediatric ambulatory conditions raises concerns regarding the promotion of resistance among colonizing enteric bacteria. This study was designed to assess the prevalence of stool colonization with resistant Gram-negative bacilli after single-dose ceftriaxone treatment compared with other regimens for acute otitis media.
  
  
  METHODS
  Children age 3 months to 7 years and diagnosed with acute otitis media were randomized to receive treatment with single-dose ceftriaxone or with oral cefprozil, amoxicillin or azithromycin. Stool samples were obtained at enrollment and then 3-5 days, 10-14 days, and 28-30 days after therapy was initiated and screened for the presence of facultative Gram-negative bacilli resistant to ceftriaxone, cefprozil, amoxicillin, piperacillin, piperacillin-tazobactam and tobramycin. Mean prevalence of colonization by resistant organisms for each treatment group was compared at each time point.
  
  
  RESULTS
  One thousand nine subjects were enrolled. The prevalence of colonization by a Gram-negative bacillus resistant to at least 1 of the screening antibiotics decreased after receipt of ceftriaxone but returned close to values measured at study entry by 30 days. A qualitatively similar pattern was noted for the 3 other regimens, but a quantitatively greater decrease in the prevalence of colonization by a resistant bacterium was noted at the 3- to 5-day and 10- to 14-day visits among azithromycin recipients (P < 0.001). Colonization by a Gram-negative bacillus resistant specifically to ceftriaxone was unusual at each study visit, regardless of treatment assignment.
  
  
  CONCLUSIONS
  A single intramuscular dose of ceftriaxone had a similar effect on the prevalence of antibiotic-resistant Gram-negative facultative bacilli in the stool of healthy children when compared with commonly used oral agents.
authors.affiliation: Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. pxt2@case.edu
authors.forename: Philip
authors.initials: P
authors.lastname: Toltzis
authors.forename: Michael
authors.initials: M
authors.lastname: Dul
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: O'Riordan
authors.forename: Hasida
authors.initials: H
authors.lastname: Toltzis
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Blumer
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D005243:Feces / Q000382:microbiology*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D010033:Otitis Media / Q000188:drug therapy* / Q000382:microbiology*; D000097670:Cefprozil
chemical_list: D000658:Amoxicillin; D000900:Anti-Bacterial Agents; D017963:Azithromycin; D002443:Ceftriaxone; D002511:Cephalosporins; D000097670:Cefprozil