Comparison of cefuroxime axetil and amoxicillin-clavulanate suspensions in treatment of acute otitis media with effusion in children.

Two hundred sixty-three pediatric patients from the ages of 3 months to 11 years were enrolled in a randomized, investigator-blinded, multicenter study comparing the clinical and bacteriological efficacies and safety of cefuroxime axetil suspension (CAE) with those of amoxicillin-clavulanate suspension (AMX-CL) in the treatment of acute otitis media with effusion. Patients received CAE at 30 mg/kg of body weight per day (n = 165) in two divided doses or AMX-CL at 40 mg/kg/day (n = 98) in three divided doses for 10 days. The primary pathogens among 200 isolates from pretreatment cultures of middle ear fluid were identified as follows: Haemophilus influenzae (39%), over a third of which were beta-lactamase positive; Streptococcus pneumoniae (34%); and Moraxella catarrhalis (16%). Pathogens were eradicated or presumed to be eradicated from 81% (95 of 118) and 76% (50 of 66) of bacteriologically evaluable patients in the CAE and AMX-CL groups, respectively. A satisfactory clinical response (cure or improvement with or without resolution of effusion) occurred in 113 (77%) of 146 clinically evaluable patients in the CAE group and in 66 (74%) of 89 evaluable patients in the AMX-CL group. Clinical failure or recurrence (within 2 weeks following the completion of treatment) occurred in 22 and 26% of CAE- and AMX-CL-treated patients, respectively. Drug-related adverse events occurred in 18% of CAE-treated patients, whereas they occurred in 39% of AMX-CL-treated patients (P < 0.001); diarrhea or loose stools was the most commonly reported adverse event (CAE, 12%; AMX-CL, 31%; P < 0.001). These results indicate that CAE given twice daily is as effective as AMX-CL given three times daily in the treatment of acute otitis media with effusion in pediatric patients, but CAE was associated with significantly fewer drug-related adverse events.

Development of serum bactericidal activity following nontypable Haemophilus influenzae acute otitis media.

We monitored the development of serum bactericidal antibody in eight children with acute nontypable Haemophilus influenzae otitis media and correlated its development with the appearance of antibody against lipooligosaccharide and surface-exposed outer membrane proteins of the infecting strains. Complement-dependent bactericidal activity was absent in acute sera but increased to titers of 1:4 to 1:32 in sera obtained 4 to 6 weeks later. Absorption of anti-lipooligosaccharide antibodies from convalescent sera had no effect on bactericidal titers of five patients and resulted in small decreases in titer in three patients. Lipooligosaccharide-absorbed samples had persisting bactericidal titers of 1:4 to 1:16. Four of eight acute samples lacked antibodies to surface-exposed outer membrane proteins whereas four had low concentrations of antibody directed against one or more Mr 100,000 to 250,000 outer membrane proteins. Convalescent samples from all eight children showed substantial increases in antibodies directed primarily against Mr 100,000 to 250,000 proteins. Thus, both surface-exposed Mr 100,000 to 250,000 outer membrane proteins and lipooligosaccharide are immunogenic during Haemophilus otitis media and are potential targets of bactericidal antibody.

Systemic antibiotics for treatment of the conjunctivitis-otitis media syndrome.

In a private pediatric practice setting 114 episodes of conjunctivitis-otitis syndrome were treated with orally administered antibiotics. In 108 (95%) of these infections Haemophilus influenzae was isolated from the pretreatment cultures of the conjunctivae; 61 were susceptible and 47 (44%) were resistant to ampicillin by a disc diffusion technique. Six cultures grew Streptococcus pneumoniae, all ampicillin-susceptible. Symptoms of conjunctivitis disappeared in 2 to 3 days in all but one patient. Of the 48 follow-up conjunctival cultures 3 to 5 days after start of therapy, 46 grew no pathogens.

Bacterial etiology of conjunctivitis-otitis media syndrome.

Simultaneous cultures of conjunctivae and middle ear exudates were obtained from 20 episodes of the syndrome of purulent conjunctivitis and otitis media. Paired cultures from 18 episodes yielded Haemophilus influenzae at both sites. In two cases with prior topical antibacterial therapy of the conjunctivitis, H influenzae was isolated from the middle ear exudate only. Biotyping and outer membrane protein analysis of H influenzae isolates from five patients demonstrated that: conjunctival and middle ear strains were concordant in all cases, and all five patients had different strains. The conjunctivitis-otitis media syndrome is most often caused by strains of nontypable H influenzae of diverse clonotype.

Conjunctivitis-otitis syndrome.

Purulent conjunctivitis associated with otitis media was studied in 124 patients in a private practice over a period of one year. Of the 132 patients seen with purulent conjunctivitis, 96 (73%) concurrently had otitis media. In 29 (47%) of 60 families with more than one child, siblings of the index cases had either purulent conjunctivitis or otitis media, or both, simultaneously or within one month. During the study period, conjunctival cultures were obtained from 75 patients with purulent conjunctivitis-otitis media and patients with purulent conjunctivitis whose siblings had purulent conjunctivitis-otitis media or otitis media. Haemophilus influenzae was isolated from 55 (73%). Thirty-one of the patients had nasal cultures done simultaneously with conjunctival cultures. An identical pathogen was isolated from 27 (87%) patients.

Chromosome banding anomalies in acute myeloid leukaemia.

Chromosome analysis in two cases of acute myeloid leukaemia are reported. On the basis of slight aberrations in the banding pattern marker chromosomes were observed in both cases. In one case a widened C-band of an additional D chromosome, and in the other case an unusual negative fluorescent band below the centromere of one of the chromosomes 16, were seen.