Two Alternatives to Ampicillin for Paediatric Otitis Media Both cefaclor and co-trimoxazole seem equally effective The changing incidence of acute otitis media due to ampicillin-resistant /3-lactamase-producing Haemophilus influenzae suggests that alternative agents may be necessary. For this reason a prospective double-blind comparison study of the efficacy and safety of cefaclor and co-trimoxazole for paediatric otitis media was performed. 100 children (mean age 23.6 months) with acute otitis media received either cefac!or (40 mgjkgjday tid) or co-trimoxazole (trimethoprim 8mg and sulphamethoxazole 40 mgj kgjday bid) for 10 days. Of the 50 patients in each group, 20 on cefaclor and 18 on co-trimoxazole had experienced recurrent episodes of otitis. Streptococcus pneumoniae (pneumococcus), S. pyogenes and H. influenzae were the main pathogens isolated. 48 hours after therapy commenced, 6 children on co-trimoxazole and 3 on cefaclor were still experiencing some symptoms However, at 96 hours all children were symptom-free. Residual effusion in the untapped ear was noted in 3 of the 15 on cefac!or and 3 of the 16 on co-trimoxazole with bilateral disease. SIX patients were considered treatment failures at 10 days and underwent repeat tympanocentesis . Four of these patients were on cefacior and 2 on co-trimoxazole but the difference was not significant. Three of the cefaclor failures responded to a further 10 days' therapy with cefaclor 80 mgjkg. One of the co-trimoxazole failures also responded to 10 days' treatment with cefaclor, but the other with a Staphylococcus aureus isolate remained resistant to therapy. No undesirable effects on hepatic, rena!, or bone marrow function were detected in either group. Cefaclor and co-trimoxazole would therefore seem to be equally efficacious in the treatment of otitis media in children, and either agent could be used as a substitute for ampicillin. mumI"

J L et 81

Pediatric Infectious Disease 3. 25 (Jan-Feb 1984)

0156-2703/84/0505-0011/0$01.00/0

© ADtS Press

tNPHARMA'" 5 May 1984

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