Foglé-Hansson Margaretha, White Peter, Hermansson Ann
Department of Otorhinolaryngology, Central Hospital, S-541 85 Skövde, Sweden.
Int J Pediatr Otorhinolaryngol. 2003 May;67(5):511-6. doi: 10.1016/s0165-5876(03)00008-9.
To investigate whether intermittent short-term courses of penicillin V (PcV) administered as intermittent prophylaxis against acute otitis media (AOM) during upper respiratory tract infections altered the nasopharyngeal bacterial flora and/or its susceptibility to penicillin.
In a double blind, placebo controlled study 70 children (30 in the PcV group and 40 in the placebo group) were followed for 1 year. At episodes of upper respiratory tract infection the children were given PcV or placebo and then seen by one of the investigators within 3 days. The tympanic membranes were examined by otomicroscopy and a culture from the nasopharynx was obtained. If AOM was found PcV was given (25 mg/kg bw b.i.d) for 5 days. If the child presented normal eardrums or signs of secretory otitis media (SOM) the study treatment was continued for a total of 5 days. All children were also examined bimonthly throughout the study irrespective of episodes of URTI or AOM.
No increase in the number of isolates of S. pneumoniae with reduced susceptibility to penicillin (MIC> or =0.125 mg/l) was noted in either group compared with the incidence in the population in Sweden at the time of the study (when ca. 10% of pneumococci had a reduced susceptibility to penicillin). The number of cultures positive for S. pneumoniae were statistically reduced in children during treatment with PcV compared with children receiving placebo, while the number of cultures positive for H. influenzae and M. catarrhalis were unaffected. No increase in the number of cultures positive for beta-lactamase producing H. influenzae was noted (ca. 10%).
Repetitive short term PcV courses during URTI in infants did not increase the number of cultures positive for S. pneumoniae with reduced susceptibility to penicillin or beta-lactamase producing H. influenzae.
研究在上呼吸道感染期间，间歇性短期使用青霉素V（PcV）作为预防急性中耳炎（AOM）的措施，是否会改变鼻咽部细菌菌群及其对青霉素的敏感性。
在一项双盲、安慰剂对照研究中，对70名儿童（PcV组30名，安慰剂组40名）进行了为期1年的随访。在上呼吸道感染发作时，给儿童服用PcV或安慰剂，然后在3天内由一名研究人员进行检查。通过耳显微镜检查鼓膜，并获取鼻咽部培养物。如果发现患有AOM，则给予PcV（25mg/kg体重，每日两次），持续5天。如果儿童鼓膜正常或有分泌性中耳炎（SOM）迹象，则继续进行研究治疗，总共持续5天。在整个研究过程中，所有儿童无论是否有上呼吸道感染（URTI）或AOM发作，均每两个月接受一次检查。
与研究期间瑞典人群中的发病率相比（当时约10%的肺炎球菌对青霉素敏感性降低），两组中对青霉素敏感性降低（最低抑菌浓度[MIC]≥0.125mg/L）的肺炎链球菌分离株数量均未增加。与接受安慰剂的儿童相比，PcV治疗期间儿童中肺炎链球菌培养阳性数量在统计学上有所减少，而流感嗜血杆菌和卡他莫拉菌培养阳性数量未受影响。产β-内酰胺酶流感嗜血杆菌培养阳性数量未增加（约10%）。
婴儿上呼吸道感染期间重复短期使用PcV疗程，不会增加对青霉素敏感性降低的肺炎链球菌或产β-内酰胺酶流感嗜血杆菌的培养阳性数量。
