6 CURRENT ISSUES

Acute otitis media: consensus recommendations

Oral amoxicillin remains the best first-line treat­ment for uncomplicated acute otitis media (AOM), despite the increasing prevalence of drug-resistant Streptococcus pneumoniae (DRSP), reports the US-based DRSP Therapeutic Working Group.

Providing consensus recommendations for the management of AOM, the researchers consider that the standard amoxicillin dosage can be raised from 40-45 mglkg/day to 80-90 mglkg/day for the first­line treatment of high-risk patients, with no increase in adverse treatment-related effects. Patients who are at very low risk for DRSP infection should receive amoxicillin 40-45 ~g/kg/day. If amoxicillin fails to improve the signs and symptoms of AOM after 3 days, suitable alternative agents include oral amoxicillin/clavulanic acid or cefuroxime axetil and IM ceftriaxone.

The researchers note that while several fluoroquinolones have recently been approved in the US for the treatment of respiratory tract infections in adults, none of these agents have been approved for use in children.

The researchers also recommend improving surveillance for drug-resistantS. pneumoniae at the national level in the US, for generating general empirical treatment recommendations in the management of AOM.

Dowell SF, Butler JC, Giebink GS, Jacobs MR. Drug-resistant Streptococc1<s Pne~<moniae Therapeutic Working Group. Acute otitis media: management and surveillance in an era of pneumococcal resistance -a report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group. Pediatric Infectious Disease Journal 18: 1-9. Jan 1999

PharmacoEconom1cs & Outcomes News 27 Feb 1999 No. 201 1173-5503/99/0201-0006/$01.00° Adis International Limited 1999. All rights reserved