Roger G, Carles P, Pangon B, Thien H V, Polonovski J M, Begue P, Garabedian E N
Department of Pediatric ENT, Hôpital d'Enfants Armand Trousseau, Paris, France.
Pediatr Infect Dis J. 1998 Jul;17(7):631-8. doi: 10.1097/00006454-199807000-00011.
To assess the clinical outcome and risk of failure after oral vs. intravenous treatment in otitis media caused by penicillin-resistant pneumococci. To determine the possible correlations between pneumococcal minimal inhibitory concentration (MIC) to penicillin and clinical outcome.
Retrospective study of 156 cases collected between 1993 and 1995. Mean follow-up: 5 months. Setting. Two tertiary academic medical centers in Paris, France.
Pneumococcus was isolated from 191 of 570 ear samples obtained from children with otitis media and shown to be penicillin-resistant in 156. Medical history, antibiotic therapy during the previous 3 months and day-care center attendance were reviewed. For the current episode microbiologic characteristics of the isolated strains, type of treatment, therapy efficacy and clinical outcome were analyzed. Patients were predominantly young (76.3% were <1 year old) and bacteriologic samples were taken mainly because of previous treatment failure.
Among 156 children with pneumococcal penicillin-resistant otitis media, 72.2% attended day-care centers, 71.8% had been previously treated with aminopenicillin and 52.5% with cephalosporins. Failure of previous empirical oral therapy was noted in 84% (one-third of these had been receiving amoxicillin-clavulanate). Patients treated intravenously had had a more protracted otitis but no greater number of previous episodes of acute otitis media than those receiving oral therapy. Acute mastoiditis occurred in 4 infants resulting in mastoidectomy. Oral treatment (mainly with high dose amoxicillin,120 to 150 mg/kg/day) and intravenous therapy (cephalosporin or glycopeptide) had been used in 59 and 41%, respectively. Mean duration of therapy was 10.7 days. Three failures (1.9%) and 10 recurrences (6.4%, average 28 days) occurred. No statistical difference was found between intravenous and oral therapy with respect to risk of recurrence. A high penicillin MIC value was correlated with previous antibiotic treatment but not with clinical outcome.
Oral therapy appears to be as effective as intravenous therapy for the treatment of penicillin-resistant pneumococcal otitis media. Intravenous treatment should not necessarily be dictated by the penicillin susceptibility value but should be considered in cases of failure to thrive, persistent otitis or other complications.
评估口服与静脉治疗耐青霉素肺炎球菌所致中耳炎后的临床结局及治疗失败风险。确定肺炎球菌对青霉素的最低抑菌浓度（MIC）与临床结局之间的可能相关性。
对1993年至1995年间收集的156例病例进行回顾性研究。平均随访时间：5个月。研究地点：法国巴黎的两家三级学术医疗中心。
从570例中耳炎患儿的耳部样本中分离出肺炎球菌191株，其中156株显示对青霉素耐药。回顾病史、前3个月的抗生素治疗情况及日托中心出勤情况。分析本次发病时分离菌株的微生物学特征、治疗类型、治疗效果及临床结局。患者以幼儿为主（76.3%年龄<1岁），采集细菌学样本主要是因为先前治疗失败。
在156例耐青霉素肺炎球菌性中耳炎患儿中，72.2%去过日托中心，71.8%先前接受过氨基青霉素治疗，52.5%接受过头孢菌素治疗。先前经验性口服治疗失败率为84%（其中三分之一接受阿莫西林-克拉维酸治疗）。接受静脉治疗的患者中耳炎病程更长，但急性中耳炎发作次数并不比接受口服治疗的患者多。4例婴儿发生急性乳突炎，需行乳突切除术。口服治疗（主要为高剂量阿莫西林，120至150mg/kg/天）和静脉治疗（头孢菌素或糖肽类）分别占59%和41%。平均治疗时间为10.7天。发生3例治疗失败（1.9%）和10例复发（6.4%，平均28天）。静脉治疗与口服治疗在复发风险方面无统计学差异。青霉素MIC值高与先前抗生素治疗有关，但与临床结局无关。
口服治疗耐青霉素肺炎球菌性中耳炎似乎与静脉治疗同样有效。静脉治疗不一定由青霉素敏感性值决定，但在发育不良、持续性中耳炎或其他并发症的情况下应予以考虑。
