Clinical Outcomes Associated with Amoxicillin Treatment for Acute Otitis Media in Children.
Clinical Outcomes Associated with Amoxicillin Treatment for Acute Otitis Media in Children.
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阿莫西林治疗儿童急性中耳炎的临床结果。
DOI：
10.1093/jpids/piae010
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发表时间：
2024
影响因子：
3.2
通讯作者：
Jenkins,TimothyC
中科院分区：
文献类型：
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作者：
Frost,HollyM;Keith,Amy;Fletcher,DanaR;Sebastian,Thresia;Dominguez,SamuelR;Kurtz,Melanie;Parker,SarahK;Wilson,MichaelL;Jenkins,TimothyC
背景急性中耳炎（AOM）是儿童服用抗生素的最常见原因。产生 β-内酰胺酶的细菌是 AOM 越来越常见的原因，并且可能对阿莫西林（目前推荐的 AOM 治疗方法）具有耐药性。我们的目的是评估接受阿莫西林治疗 AOM 的儿童的临床结果，并评估结果是否因感染病原体或 β-内酰胺酶的产生而异。方法纳入了 205 名诊断患有 AOM 并服用阿莫西林的 6-35 个月大儿童。对入组时收集的鼻咽拭子进行细菌培养和定性多重实时聚合酶链反应。家长完成了评估症状、抗生素依从性和潜在不良事件的调查。主要结局是阿莫西林治疗失败。次要结局包括复发、症状改善、缓解和药物不良事件 (ADE)。结果 8 名儿童 (5.4%) 治疗失败，14 名儿童 (6.8%) 复发。到第 5 天，152 名（74.1%）名儿童的症状有所改善，97 名（47.3%）名儿童的症状得到缓解。家长报告了 56 名 (27.3%) 儿童的 ADE。在入组前未服用任何阿莫西林的 149 名儿童中，98 名（65.8%）患有一种或多种产生 β-内酰胺酶的细菌。常见细菌性耳病原菌为卡他莫拉菌(79例, 53.0%)、肺炎链球菌(51例, 34.2%)、流感嗜血杆菌(30例, 20.1%)、金黄色葡萄球菌(21例, 14.1%)。患有（5名，5.1％）和不患有（3名，5.9％）产生β-内酰胺酶的耳病原体的儿童之间的治疗失败没有差异（p = .05）。结论在接受阿莫西林治疗的诊断为AOM的儿童中，治疗失败并不常见，并且与病原体或β-内酰胺酶的产生无关。尽管产生 β-内酰胺酶的细菌越来越普遍，这些数据支持推荐阿莫西林的指南。
BackgroundAcute 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.Methods205 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).Results8 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 wereMoraxella catarrhalis(79, 53.0%),Streptococcus pneumoniae(51, 34.2%),Haemophilus influenzae(30, 20.1%), andStaphylococcus 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).ConclusionsAmong 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.