Three Days of IM Ceftriaxone for Nonresponsive AOM

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Article| March 01 1999 Three Days of IM Ceftriaxone for Nonresponsive AOM AAP Grand Rounds (1999) 1 (3): 18. https://doi.org/10.1542/gr.1-3-18 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Three Days of IM Ceftriaxone for Nonresponsive AOM. AAP Grand Rounds March 1999; 1 (3): 18. https://doi.org/10.1542/gr.1-3-18 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: ceftriaxone, unresponsive to stimuli Source: Leibovitz E, Piglansky L, Raiz S, et al. Bacteriologic efficacy of a three-day intramuscular ceftriaxone regimen in nonresponsive acute otitis media. Pediatr Infect Dis J. 1998;17:1126–31. The care of children with symptomatic acute otitis media (AOM) unresponsive to antibiotics remains challenging. In this study, the authors identified children (ages 3 to 36 months) with non-responsive AOM “defined as persistent or relapsing AOM for which an antibiotic was administered” for at least 48 hours in the previous 2 weeks. They performed tympanocentesis for bacterial culture and then administered intramuscular ceftriaxone (50 mg/kg/day) for 3 days. Between days 4 and 10, a second tympanocentesis was obtained to assess bacteriologic eradication. The children were then followed up to 17 days to observe for relapse. Ninety-two of 94 children with positive middle ear fluid cultures completed this protocol. Of a total of 105 isolates, 54 of 54 Haemophilus influenzae, 41 of 47 Streptococcus pneumoniae, 1 of 2 Moraxella catarrhalis, and 2 of 2 Streptococcus pyogenes were successfully eradicated as demonstrated by no growth on the second tympanocentesis – a 93% success rate. Of the S. pneumoniae isolates, 13 were penicillin susceptible and 34 were intermediately resistant to penicillin. Of note, all 4 treatment failures involving S. pneumoniae were from strains with intermediate resistance to penicillin. There were an additional 2 relapses following therapy and these also involved strains with intermediate resistance to penicillin. All patients with treatment failure or relapse due to S. pneumoniae responded to an additional 3–7 day course of ceftriaxone. The results of this study suggest that the child with persistent symptomatic acute otitis media, despite oral antibiotics, may benefit from ceftriaxone therapy. Other therapeutic alternatives for patients who fail to respond to initial antibiotic therapy include amoxicillin-clavulanate, cefuroxime axetil, cefprozil, erythromycin/sulfisoxazole, and trimethoprim-sulfamethoxazole.1 Drug selection will depend on patient and physician preferences and knowledge of current community microbial susceptibility patterns. It is unclear how many of the study children had received the higher doses of amoxicillin or amoxicillin-clavulanate currently recommended. This is not a trivial point, because these were the antimicrobials previously administered to 63% of the total study population. Amoxicillin in doses of 80–90 mg/kg/day (versus the traditional 25–50 mg/kg/day) achieves middle ear concentrations sufficient to eradicate the vast majority of intermediately resistant (MIC 0.1–1.0μg/ml) and many highly resistant (MIC ≥2.0 μg/ml) S. pneumoniae.2 Since none of the S. pneumoniae isolates in the study by Leibovitz et al were highly penicillin-resistant, the efficacy of ceftriaxone therapy in such patients requires further investigation. This study provides some welcome guidance for the treatment of the symptomatic child who has failed initial therapy. However, as Drs Barton and Clary note: optimal initial antibiotic treatment of those children whose otitis does not resolve without treatment may reduce the number of non-responders. You do not currently have access to this content.