[Current therapeutical management, new antibiotics and treatment of Pseudomonas aeruginosa in bacterial ENT-infections]

Abstract

In bacterial infections of the sinuses and the middle ear Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus are most frequently isolated, whereas in tonsillopharyngitis Streptococcus pyogenes is the most important pathogen. S. aureus is found in up to 40 % in acute and chronic sinusitis and causes severe complications in otitis media, therefore antibiotics used as empirical initial treatment should also be effective against this pathogen. To decrease duration of illness and to avoid serious complications antibiotic treatment of bacterial ENT-infections is necessary. The new ketolides and the third and fourth generation quinolones are very effective and the second generation cephalosporins like cefuroxime axetil have proven excellent clinical and bacteriological efficacy in numerous clinical trials combined with an excellent resistance pattern over the years. Efficacy of short course therapy (5 days) in sinusitis and tonsillopharyngitis has been proven in clinical trials and is cost saving. In more severe infections treated in hospital sequential i. v./oral therapy offers pharmaco-economical benefits. Both regimen demonstrate cost savings while maintaining high clinical efficacy. In more severe infections like otitis externa diffusa, otitis externa maligna, otitis media chronica and perichondritis Pseudomonas aeruginosa is a dangerous pathogen that has to be covered by initial antibiotic treatment. Ciprofloxacin and Ceftazidime are widely used and effective. Ciprofloxacin resistance has increased, while Ceftazidime susceptibility is unchanged (> 90 %). A dose reduction study with ceftazidime in severe ENT-infections showed equivocal efficacy between 3 x 1 g and 3 x 2 g daily that offers a cost benefit of 50 %.