The Effects of Treatment of Acute Otitis Media With a Low Dose vs a High Dose of Amoxicillin on the Nasopharyngeal Flora.
Brook, Itzhak MD, MSc; Gober, Alan E. MD
[Article]
Archives of Otolaryngology -- Head & Neck Surgery.
135(5):458-461, May 2009.
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Objective: To compare the effects on the nasopharyngeal flora of therapy of acute otitis media in children with either a low dose or a high dose of amoxicillin.
Design: Retrospective study.
Patients: Of 50 children diagnosed as having acute otitis media, 25 received a low dose of amoxicillin (45 mg/kg/d) (group 1) and 25 received a high dose of amoxicillin (90 mg/kg/d) (group 2) for 10 days, and both groups were evaluated.
Intervention: Antimicrobial treatment.
Results: Before therapy, potential pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus) were isolated from the nasopharynx of 15 children in group 1 (60%) and 13 in group 2 (52%). The number of penicillin-susceptible isolates was equally reduced after both therapies. However, an increase was noted in the recovery of S aureus only in group 2 (from 2 to 6 organisms). A greater eradication rate of interfering organisms following therapy was noted in group 2 (from 86 to 36) than in group 1 (from 92 to 60) (P < .001). These organisms include [alpha]-hemolytic streptococci, and Peptostreptococcus and Prevotella species.
Conclusions: The oral flora at the end of therapy with a high dose of amoxicillin is more depleted of organisms with interfering capability than following treatment with a low dose of amoxicillin. These changes may contribute to the greater recovery rate of patients infected with S aureus who received a high dose of amoxicillin.
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