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. 2024 Mar 19;13(3):203-210.
doi: 10.1093/jpids/piae010.

Clinical Outcomes Associated with Amoxicillin Treatment for Acute Otitis Media in Children

Holly M Frost  1   2   3 , Amy Keith  2 , Dana R Fletcher  4 , Thresia Sebastian  1   3   5 , Samuel R Dominguez  6   7 , Melanie Kurtz  2 , Sarah K Parker  6   7 , Michael L Wilson  8   9 , Timothy C Jenkins  10   11
Affiliations

Clinical Outcomes Associated with Amoxicillin Treatment for Acute Otitis Media in Children

Holly M Frost et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Acute otitis media (AOM) is the most common reason children are prescribed antibiotics. Bacteria that produce beta-lactamase are an increasingly frequent cause of AOM and may be resistant to amoxicillin, the currently recommended treatment for AOM. We aimed to evaluate the clinical outcomes of children treated with amoxicillin for AOM and assessed whether outcomes vary by infecting pathogen or beta-lactamase production.

Methods: 205 children 6-35 months old diagnosed with AOM and prescribed amoxicillin were included. Bacterial culture and qualitative multiplex real-time polymerase chain reaction were performed on nasopharyngeal swabs collected at enrollment. Parents completed surveys assessing symptoms, antibiotic adherence, and potential adverse events. The primary outcome was treatment failure with amoxicillin. Secondary outcomes included recurrence, symptom improvement, resolution, and adverse drug events (ADE).

Results: 8 children (5.4%) experienced treatment failure and 14 (6.8%) had recurrence. By day 5, 152 (74.1%) children had symptom improvement and 97 (47.3%) had resolution. Parents reported ADE for 56 (27.3%) children. Among 149 children who did not take any amoxicillin before enrollment, 98 (65.8%) had one or more beta-lactamase-producing bacteria. Common bacterial otopathogens were Moraxella catarrhalis (79, 53.0%), Streptococcus pneumoniae (51, 34.2%), Haemophilus influenzae (30, 20.1%), and Staphylococcus aureus (21, 14.1%). Treatment failure did not differ between children that did (5, 5.1%) and did not (3, 5.9%) have beta-lactamase-producing otopathogens (p = .05).

Conclusions: Among children diagnosed with AOM treated with amoxicillin, treatment failure was uncommon and did not differ by pathogen or beta-lactamase production. These data support guidance recommending amoxicillin despite an increasing prevalence of beta-lactamase-producing bacteria.

Keywords: PCR; acute otitis media; antibiotic stewardship; diagnostics; pediatrics; treatment outcomes.

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Figures

Figure 1.
Figure 1.
Study Schematic.
See this image and copyright information in PMC

References

    1. Kaur R, Morris M, Pichichero ME. Epidemiology of acute otitis media in the postpneumococcal conjugate vaccine era. Pediatrics 2017; 140:e20170181. - PMC - PubMed
    1. Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics 2011; 128:1053–61. - PubMed
    1. Kaur R, Fuji N, Pichichero ME. Dynamic changes in otopathogens colonizing the nasopharynx and causing acute otitis media in children after 13-valent (PCV13) pneumococcal conjugate vaccination during 2015-2019. Eur J Clin Microbiol Infect Dis 2022; 41:37–44. - PubMed
    1. Wald ER, DeMuri GP. Antibiotic recommendations for acute otitis media and acute bacterial sinusitis: conundrum no more. Pediatr Infect Dis J 2018; 37:1255–7. - PMC - PubMed
    1. Broides A, Dagan R, Greenberg D, Givon-Lavi N, Leibovitz E. Acute otitis media caused by Moraxella catarrhalis: epidemiologic and clinical characteristics. Clin Infect Dis 2009; 49:1641–7. - PubMed

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