existing guidelines recommend treat...

existing guidelines recommend treatment of high-dose amoxicillin for children with acute otitis media (AOM) who are at high risk for infection with non-susceptible Streptococcus pneumoniae (NSSP) This includes all patients who are younger than brace years, attend day care, or have freshly been exposed to antibiotics. High-dose amoxicillin (80 to 90 mg for kg per day, twice the standard dosage) may not be urgencyed if NSSP prevalence is soft in the local area. However, prevalence data in succession NSSP is limited. Garbutt and colleagues used data from nasopharyngeal cultivations to estimate the prevalence of NSSP in individual city, and to develop community-specific treatment guidelines based forward local susceptibility.

Patients from seven pediatric offices were enlisted in the study; the inclusion criteria were age younger than seven years and a modern diagnosis of AOM or single of several other upper respiratory infections. A posterior nasopharyngeal swab was obtained from each child. Minimum inhibitory concentrations (MIC) were then measured in succession S. pneumoniae specimens. Isolates with an MIC of 012 [micro]g by mL or higher were considered resistant to penicillin and were labeled NSSP; isolates with an MIC of greater than 2 [micro]g by mL were considered resistant to standard-dose amoxicillin and were labeled NSSP-A. Parents complet a scan identifying risk factors for infection with NSSP including day-care attendance, number of children at abiding-place and recent antibiotic use.

Of the 212 participating children, 70 (33 percent) had nonspecific upper respiratory infection (URI) and 58 (27 percent) had AOM, the greatest in quantity frequent diagnoses. Twenty-nine (50 percent) of the children with AOM had positive nasopharyngeal swabs, as did 11 (48 percent) of those with otitis media with effusion, eight (33 percent) of those with acute sinusitis, and 30 (43 percent) of those with URI. About individual quarter of isolates were highly resistant and united quarter were intermediately resistant to penicillin. NSSP prevalence in the studious mood sample was 19 percent. Attendance at a day-care center was independently associated with higher NSSP carriage. Of the 85 s pneumoniae isolates, six fit the definition of NSSP-A, a prevalence of 7 percent among isolates, and 3 percent among the studious mood sample. In the NSSP isolates, there was a high resistance to other antibiotics as well as to penicillin.

In this reflection population, the authors calculate, standard-dose amoxicillin would have been effective in mostly patients treated for AOM. No more than an estimated 3 percent would have failed treatment. This percentage may in reality be calm less because, among other reasons, nasopharyngeal carriage overestimates the demeanor of the organism in the middle ear. The authors terminate that treating the local population with standard-dose amoxicillin would be adequate, with high-dose treatment reserv for day-care attendees. Although nasopharyngeal carriage does not correlate totally with middle ear isolates, this investigation demonstrates that it is relatively easy to measure local prevalence of NSSP and derive treatment recommendations accordingly. Still stand in want ofed are accurate determinations of amoxicillin resistance and more information regarding the impact of pneumococcal conjugate vaccine upon NSSP prevalence.

Garbutt J et al. Developing community-specific recommendations for first-line treatment of acute otitis media: Is high-dose amoxicillin necessary? Pediatrics August 2004;114:342-7

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