Beta-lactamase-producing strains of Haemophilus influenzae and Moraxella catarrhalis are common causes of respiratory tract infection. Johnson and associates compared cefixime, a beta-lactamase-stable cephalosporin, with amoxicillin in the treatment of acute otitis media.
A total of 126 children were included in the study. Mean age at entry into the study was 18 months; 85 percent of the children were younger than two years of age. Patients were randomized to receive 8 mg per kg per day of cefixime or 40 mg per kg per day of amoxicillin.
Tympanocentesis was performed after three to five days of therapy. Cultures of tympanocentesis specimens showed growth in 64 patients. Pathogens were eradicated from the middle ear in 27 (79.4 percent) of 34 children given amoxicillin and in 26 (86.7 percent) of 30 children given cefixime.
Among children with Streptococcus pneumoniae infection, bacteriologic cure was achieved in 14 (93.3 percent) of 15 children given amoxicillin and in 12 (75 percent) of 16 children given cefixime. In children with H. influenzae infection, cefixime was more effective (100 percent cure rate) than amoxicillin (62 percent cure rate).
The pathogens associated with failure of amoxicillin therapy were H. influenzae (five cases, two beta-lactamase positive), S. pneumoniae (one case) and M. catarrhalis (one case, beta-lactamase positive). The four treatment failures that occurred with cefixime were in patients with S. pneumoniae infection.
Rash, diarrhea and vomiting occurred with similar frequency in both groups and did not necessitate discontinuation of therapy.
The authors conclude that amoxicillin and cefixime are equivalent in overall clinical and bacteriologic efficacy for otitis media, but that cefixime is more efficacious for otitis media caused by H. influenzae. (Journal of Pediatrics, July 1991, vol. 119, p. 117.)
COPYRIGHT 1991 American Academy of Family Physicians
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