2002 Volume 50 Issue 6 Pages 352-362
Acute otitis media is one of the most common upper respiratory infection diseases in childhood. The most common organisms causing it are Streptococcus pneumoniae and Haemophilus influenzae. In children, the nasopharynx is the carrier focus for upper respiratory infection diseases such as acute otitis media, and S.pneumoniae and H. influenzae colonize the nasopharynx. We studied the changes in nasopharyngeal carriage of S. pneumoniae and H. influenzae before and after amoxicillin (AMPC) and cefditoren-pivoxil (CDTR) therapy using a polymerase chain reaction to detect penicillin-binding protein genes and macroride-resistant genes, with the following results:
1. In 25 cases, 18 showed S. pneumoniae only, 4 H. influenzae only, and 3 detected cases. In the 18 having only S. pneumoniae, 2 consisted of a different type of S. pneumoniae. In 23 strains of S. pneumoniae, 2 were penicillin-susceptible S. pneumoniae (PSSP), 4 penicillin intermediate-resistant S. pneumoniae (PISP), and 17 penicillin-resistant S. pneumoniae (PRSP). In the 7 strains of H. influenzae, 3 were β-actamase-negative ampicillin-susceptible H. influenzae (BLNAS) and 4β-lactamase-negative ampicillin-resistant H. influenzae (BLNAR).
2. All PSSP and PISP were removed from the nasopharynx with AMPC, but in PSSP, PRSP was detected in all cases after AMPC therapy, In the 17 strains of PRSP recognized initially, 2 were removed from the nasopharynx with AMPC therapy, 4 changed to other strain types with AMPC therapy, and of the 11 strains remaining, 3 new strains appeared. With CDTR (9mg/kg/day) therapy, 2 strains were removed and 16 remained. With CDTR (18mg/kg/day) therapy, 1 strain changed to another type, and 1 new strain appeared. Ultimately, 17 strains remained, but only 9 existed from the beginning.
3. All 3 BLNAS strains were removed from the nasopharynx with AMPC, CDTR (9mg/kg/day), and CDTR (18mg/kg/day) therapy. During these therapies, however, 3 BLNAS appeared and only 1 strain ultimately remained in the nasopharynx. All 4 BLNAR strains were removed from the nasopharynx with AMPC, with 3 new strains appearing and CDTR (18mg/kg/day), with 2 new strains appearing. One strain ultimately remained in the nasopharynx. All strains recognized initially were removed.
4. No relationship was seen between S. pneumoniae and H. influenzae remaining in the nasopharynx and results of acute otitis media therapy. But it was recognized the tendencies that in the good result cases the rate of the removal of the bacteria from the beginning were high and all of them removed with AMPC and in the poor result cases the removal of the bacteria from the beginning were not high and bacteria from the beginning changed to the different bacteria which had different pattern of the resistant genes.
