Is cotrimoxazole effective in the treatment of acute otitis media?
Cotrimoxazole is often used to treat acute otitis media (OSA). Israeli scientists conducted a study on the bacteriological and clinical efficacy of cotrimoxazole in the treatment of ACC.
Cotrimoxazole is often used to treat acute otitis media (OSA). Israeli scientists conducted a study on the bacteriological and clinical efficacy of cotrimoxazole in the treatment of ACC, the results of which were published in the March issue of The Pediatric Infectious Disease Journal (PIDJ ).
54 children with CCA aged 3 to 32 months with a positive culture received treatment with cotrimoxazole at a dose of 4 mg / kg in 2 doses for 10 days. The discharge from the middle ear was the subject of a cultural study before treatment, on the 4th and 5th day after the start of treatment and in the event of relapse of the symptoms of ACC. Clinical ineffectiveness has been defined as the absence of positive dynamics in disease symptoms or if a relapse has occurred during treatment. Bacteriological ineffectiveness was determined in the case of a positive culture at 4 and 5 days after the start of treatment, or when a negative culture at 4 and 5 days became positive again at the end of treatment. The patients were observed on average 28 ± 2 days.
As a result, 67 strains of microorganisms have been isolated: 24 - S.pneumoniae, 40 - H.influenzae, 3 - S.pyogenes. Fifteen (63%) of the 24 S. pneumoniae strains were resistant to cotrimoxazole (the MICs for trimethoprim are greater than 0.5 mg / ml), of which 10 (67%) were very resistant to cotrimoxazole ( The IPC for trimethoprim is greater than 4.0 mg / ml).
12 (30%) of 40 H. influenzae strains and all S.pyogenes strains were not sensitive to cotrimoxazole (BMD greater than 4.0 mg / ml). Eradication of pathogens occurred in 9 out of 9 cases (100%) and 27 out of 27 cases (100%) when S. pneumoniae and H. influenzae (respectively) were sensitive to the drug, against 4 of 15 (27%) and 6 of 12 (50%) cases where resistant strains of S. pneumoniae and H. influenzae were isolated, (P less than 0.001) The eradication of S. pyogenes was not carried out in the 3 patients. 9 new microorganisms that did not initially stand out appeared during treatment and 7 of them (77%) were resistant to cotrimoxazole. Bacteriological efficacy was not achieved in 29 (53%) of the 54 patients (the eradication of pathogens did not take place or new pathogens were released during treatment). Clinical efficacy was not achieved in 8 (15%) patients, 7 of whom did not achieve bacteriological efficacy. 10 patients recurred after the end of treatment, 8 of them underwent tympanocentesis for a study of culture of middle ear flow.
Thus, a high frequency of bacteriology and, therefore, the clinical ineffectiveness of the treatment of patients with CCA with cotrimoxazole has been revealed. According to the researchers, the data obtained once again confirms that cotrimoxazole should not be used as the drug of choice for the initial empirical treatment of CCA.