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CHOC Infectious Disease Specialist Publishes Findings on Refractory Acute Otitis Media

If there has been no response by the third round of antibiotics, or if the patient comes down with a brandnew infection shortly after repeated courses of antibiotics, culture the middle ear fluid. This recommendation was among several findings published by CHOC Infectious Disease Specialist Antonio Arrieta, M.D., in the February 2004 issue of Pediatric Infectious Disease Journal. In the study, Dr. Arrieta also compared the efficacy of several commonly used antibiotics used in high doses and reviewed new antibiotics currently under clinical trial.

Children with ear infections fall into two distinct groups, Dr. Arrieta says. About 80 percent have simple, non-refractory ear infections on a rare or occasional basis, which may be treated successfully with simple antibiotics. The other 20 percent experience multiple ear infections. These patients need different monitoring and treatment.

"Culturing the middle ear fluid in recurrent infections is necessary to confirm the presence of bacteria and to identify antimicrobial sensitivities. In this particular group of children, we have to be very judicious in the antibiotics we use, and how we use them, to prevent toxicities, as well as the emergence and spread of resistant bacteria," Dr. Arrieta says.

Dr. Arrieta reviewed the efficacy of intramuscular ceftriaxone and high-doses of amoxicillin/clavulanate and azithromycin in treating resistant strains of beta-lactamaseproducing Haemophilus influenzae, and penicillin- and macrolide-resistant Streptococcus pneumoniae, the usual culprits in refractory acute otitis media. Dr. Arrieta also examined the role of new antibiotics, including quinolones and ketolides.

While not developed specifically for acute otitis media, the pneumococcal conjugate vaccine (PREVNAR) appears to have side benefits for children with recurrent infections. Dr. Arrieta presented data suggesting that the vaccine decreases the frequency of infections and the need for surgical treatment. The vaccine may be administered at 2, 4, 6 and 18 months.

For more information about this study, please contact CHOC Infectious Disease Specialist Antonio Arrieta, M.D., at (714) 532-8403.

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