Brook Itzhak, Gober Alan E
Departments of Pediatrics, Georgetown University School of Medicine, 4431 Albemarle St NW, Washington DC 20016, USA.
J Med Microbiol. 2005 Jun;54(Pt 6):553-556. doi: 10.1099/jmm.0.45837-0.
The effect on the nasopharyngeal bacterial flora of 10 days of amoxycillin-clavulanate or cefdinir antimicrobial therapy was studied in 50 children with acute otitis media. Before therapy, 17 potential pathogens (Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis) were isolated from the nasopharynx of 14 (56%) of those treated with amoxycillin-clavulanate, and 20 potential pathogens were recovered from 15 (60%) of those treated with cefdinir. Following therapy, at days 12-15, the number of potential pathogens was reduced to a similar extent with both therapies, to three in those treated with amoxycillin-clavulanate and two in those treated with cefdinir. However, the number of potential pathogens rebounded faster in those treated with amoxycillin-clavulanate as compared with cefdinir in the two subsequent specimens taken at days 30-35 and 60-65 (12 and 18 in the amoxycillin-clavulanate group, and six and nine in the cefdinir group, P < 0.01 and P < 0.001, respectively). Differences between the groups were also noted in the recovery of organisms with interfering capability. Immediately following amoxycillin-clavulanate therapy, the number of interfering organisms declined from 54 to 13, while following cefdinir treatment their number was reduced from 59 to 39 (P < 0.001). The differences between the two therapy groups persisted in the two later specimens taken at days 30-35 and 60-65 (25 and 38 in the amoxycillin-clavulanate group, and 52 and 51 in the cefdinir group, P < 0.001 and P < 0.05, respectively). This study illustrates the potential beneficial effect of using a narrow-spectrum antimicrobial that selectively spares the interfering organisms while eliminating pathogens. The benefit of such therapy is the prevention of reacquisition of pathogenic bacteria in the nasopharynx. In contrast, utilization of a broad-spectrum antimicrobial is associated with prolonged absence of inhibitory organisms and rapid recolonization with pathogens.
在50名患有急性中耳炎的儿童中，研究了阿莫西林-克拉维酸或头孢地尼抗菌治疗10天对鼻咽部细菌菌群的影响。治疗前，在接受阿莫西林-克拉维酸治疗的患者中，14例（56%）的鼻咽部分离出17种潜在病原体（肺炎链球菌、流感嗜血杆菌和卡他莫拉菌），在接受头孢地尼治疗的患者中，15例（60%）分离出20种潜在病原体。治疗后，在第12 - 15天，两种治疗方法使潜在病原体数量减少的程度相似，接受阿莫西林-克拉维酸治疗的患者减少到3种，接受头孢地尼治疗的患者减少到2种。然而，在第30 - 35天和60 - 65天采集的后续两份标本中，与头孢地尼相比，接受阿莫西林-克拉维酸治疗的患者潜在病原体数量反弹更快（阿莫西林-克拉维酸组分别为12种和18种，头孢地尼组分别为6种和9种，P分别<0.01和<0.001）。在具有干扰能力的生物体恢复方面，两组之间也存在差异。阿莫西林-克拉维酸治疗后，干扰生物体数量从54降至13，而头孢地尼治疗后，其数量从59降至39（P<0.001）。在第30 - 35天和60 - 65天采集的两份后续标本中，两种治疗组之间的差异仍然存在（阿莫西林-克拉维酸组分别为25种和38种，头孢地尼组分别为52种和51种，P分别<0.001和<0.05）。本研究说明了使用窄谱抗菌药物的潜在有益效果，该药物在消除病原体的同时选择性地保留干扰生物体。这种治疗的益处是预防鼻咽部病原菌的重新获得。相比之下，使用广谱抗菌药物会导致抑制性生物体长期缺失，并使病原体迅速重新定植。
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