Pathogens in acute otitis media - impact of intermittent penicillin V prophylaxis on infant nasopharyngeal flora

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Abstract

Objective: To investigate whether intermittent short-term courses of penicillin V (PcV) administered as intermittent prophylaxis against acute otitis media (AOM) during upper respiratory tract infections altered the nasopharyngeal bacterial. flora and/or its susceptibility to penicillin. Methods: In a double blind, placebo controlled study 70 children (30 in the PcV group and 40 in the placebo group) were followed for 1 year. At episodes of upper respiratory tract infection the children were given PcV or placebo and then seen by one of the investigators within 3 days. The tympanic membranes were examined by otomicroscopy and a culture from the nasopharynx was obtained. If AOM was found PcV was given (25 mg/kg bw b.i.d) for 5 days. If the child presented normal eardrums or signs of secretory otitis media (SOM) the study treatment was continued for a total of 5 days. All children were also examined bimonthly throughout the study irrespective of episodes of URTI or AOM. Results: No increase in the number of isolates of S. pneumoniae with reduced susceptibility to penicillin (MIC greater than or equal to 0.125 mg/L) was noted in either group compared with the incidence in the population in Sweden at the time of the study (when ca. 10% of pneumococci had a reduced susceptibility to penicillin). The number of cultures positive for S. pneumoniae were statistically reduced in children during treatment with PcV compared with children receiving placebo, while the number of cultures positive for H. influenzae and M. catarrhalis were unaffected. No increase in the number of cultures positive for beta-lactamase producing H. influenzae was noted (ca. 10%). Conclusion: Repetitive short term PcV courses during URTI in infants did not increase the number of cultures positive for S. pneumoniae with reduced susceptibility to penicillin or beta-lactamase producing H. influenzae. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.

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Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Otorhinolaryngology

Keywords

  • penicillin V (PcV), acute otitis media (ACM), infants, Streptococcus pneumoniae, prophylaxis
Original languageEnglish
Pages (from-to)511-516
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume67
Issue number5
Publication statusPublished - 2003
Publication categoryResearch
Peer-reviewedYes