Use of oral cephalosporins in the treatment of acute otitis media in children.

The selection of the most effective antimicrobial to treat acute otitis media (AOM) has become more difficult in recent years because of increasing antibiotic resistance among all AOM pathogens. Resistance of Streptococcus pneumoniae to penicillin as well as amoxicillin ranges from 30 to 55% in the USA. Currently, 40-55% of Haemophilus influenzae and 90-100% of Moraxella catarrhalis are resistant to penicillin because of the production of Beta-lactamases. This review discusses the availability of oral cephalosporins that can be utilised for the treatment of AOM in children. An evaluation is made regarding their in vitro activity against the pathogens, their middle-ear concentrations, pharmacokinetics and pharmacodynamics (PK/PD). The cephalosporins that will be discussed are cefuroxime-axetil, cefprozil, cefdinir and cefpodoxime-proxetil. The current recommendations for therapy of AOM limit the choices of clinicians to a single cephalosporin (cefuroxime-axetil). However, clinical, bacteriological and PK/PD data shows that several other cephalosporins (cefprozil, cefdinir and cefpodoxime-proxetil) possess similar indices which provide the clinician with wider therapeutic choices that can insure better compliance and ultimately better success in eradication of the infection.