Among patients with severe acute otitis media under 3 years of age who visited my clinic between January 2006 and December 2007, amoxicillin (70mg/kg/day)/clavulanic acid (5mg/kg/day)(AMPC/CVA (14: 1)) was administered for 7 days to 105 patients in whom either
S. pneumoniae, S. pyogenes, M. catarrhalis, or
H. influenzae was detected from the nasopharynx. Changes in bacteria detected in the nasopharynx before and after administration were investigated, and the following results were obtained:
1. Bacteria detected before administration were 42 strains of
S. pneumoniae (23 strains of drug resistant
S. pneumoniae)(27%), 4 strains of
S. pyogenes (3%), 14 strains of
M. catarrhalis (9%), and 95 strains of
H influenzae (70 strains of ampicillin (ABPC)-resistant
H influenzae)(61%); and the disappearance rates of bacteria were 88% in
S. pneumoniae, 100% in
S. pyogenes, 100% in
M. catarrhalis, and 52% in
H influenzae, showing significantly higher disappearance rates of
S. pneumoniae and
M. catarrhalis than
H. influenzae.
2. Of 57 strains of bacteria detected after administration, there were 47 strains of
H influenzae detected at a high rate (82%), among which 38 strains were ABPC-resistant
H influenzae.
3. The detection rate of β-lactamase-producing
H influenzae increased significantly from 7 of 95 strains (7%) before administration, to 10 of 47 strains (21%) after administration.
4. After administration of AMPC/CVA (14: 1), it should be paid attention to remnants of ABPC-resistant
H.influenzae such as β-lactamase-producing bacteria.
5. When patients treated with AMPC and patients treated with AMPC/CVA (14: 1) were compared, the disappearance rates of
S pneumoniae, M. catarrhalis, and
H. influenzae were all higher in patients treated with AMPC/CVA (14: 1), with significant differences in
M. catarrhalis, H. influenzae, and β-lactamase non-producing ABPC sensitive
H. influenzae. It was shown that AMPC/CVA (14: 1) might be more effective than AMPC for the removal of bacteria from the nasopharynx.
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