Resistance to Antimicrobials Used for Therapy of Otitis Media and Sinusitis: Effect of Previous Antimicrobial Therapy and Smoking

Abstract

We undertook to identify the antimicrobial susceptibility of the pathogens isolated from patients with otitis media or maxillary sinusitis who failed to respond to antimicrobial therapy, and correlate it with previous antimicrobial therapy and smoking. We analyzed isolates recovered from 2 consecutive cultures obtained from middle ear aspirate obtained through an open perforation in 22 children with otitis, and maxillary sinus aspirate collected by endoscopy from 20 patients. Forty-seven isolates were repeatedly recovered from 42 culture-positive individuals. The organisms isolated were Streptococcus pneumoniae (15 isolates), Haemophilus influenzae (14), Staphylococcus aureus (7), Moraxella catarrhalis (6), and Streptococcus pyogenes (5). Resistance of at least 2 tube dilutions to the antimicrobial agents used was found in 23 of the 47 (49%) isolates that were found in 20 (48%) of the patients. These included 10 of 15 (67%) isolates of S pneumoniae, 4 of 14 (29%) H influenzae (all were β-lactamase producers), 4 of 7 (57%) S aureus (all β-lactamase producers), 5 of 6 (83%) M catarrhalis (all β-lactamase producers), and none of 5 S pyogenes. In the 21 patients who failed to respond to amoxicillin, H influenzae and S pneumoniae predominated. Streptococcus pneumoniae was recovered from 4 of the 11 (36%) after trimethoprim-sulfamethoxazole, 4 of 21 (19%) after amoxicillin, 2 of 3 (67%) after azithromycin dihydrate, and 1 of 4 (25%) after cefixime. A statistically significant higher recovery of resistant organisms was noted in those treated 2 to 6 months previously, and in those with sinusitis who smoked. The data illustrate the relationship between resistance to antimicrobials and failure of patients with otitis media and sinusitis to improve.

Keywords

antimicrobials Haemophilus influenzae Moraxella catarrhalis otitis media sinusitis smoking Streptococcus pneumoniae

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References

Teele

Pelton

Klein

. Bacteriology of acute otitis media unresponsive to initial antimicrobial therapy. J Pediatr 1981;98:537–9.

Harrison

Marks

Welch

. Microbiology of recently treated acute otitis media compared with previously untreated acute otitis media. Pediatr Infect Dis 1985;4:641–6.

Carlin

Marchant

Shurin

Johnson

Murdell-Panek

Barenkamp

. Early recurrences of otitis media: Reinfection or relapse?. J Pediatr 1987;110:20–5.

Barenkamp

Shurin

Marchant

. Do children with recurrent Haemophilus influenzae otitis media become infected with a new organism or reacquire the original strain?. J Pediatr 1984;105:533–7.

Del Beccaro

Mendelman

Inglis

. Bacteriology of acute otitis media: A new perspective. J Pediatr 1992;120:81–4.

Pichichero

. Persistent otitis media: I. Causative pathogen. Pediatr Infect Dis J 1995;14:178–83.

Brook

Yocum

. Bacteriology and β-lactamase activity in ear aspirates of acute otitis media that failed amoxicillin therapy. Pediatr Infect Dis J 1995;14:805–7.

Brook

Frazier

. Microbial dynamics of persistent otitis media in children. J Pediatr 1996;128:237–40.

Brook

Frazier

Foote

. Microbiology of the transition from acute to chronic maxillary sinusitis. J Med Microbiol 1996;45:372–5.

10.

National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. 4th ed. M7-A4. Villanova, Pa: National Committee for Clinical Laboratory Standards, 1995.

11.

O'Callaghan

Morris

Kirby

Shingler

. Novel method for detection of beta-lactamase by using a chromogenic cephalosporin substrate. Antimicrob Agents Chemother 1972;1:283–8.

12.

Chonmaitree

Owen

Patel

Hedgpeth

Horlick

Howie

. Presence of cytomegalovirus and herpes simplex virus in middle ear fluids from children with acute otitis media. Clin Infect Dis 1992;15:650–3.

13.

Ednie

Spangler

Jacobs

Appelbaum

. Susceptibilities of 228 penicillin- and erythromycin-susceptible and -resistant pneumonococci to RU 64004, a new ketolide, compared with susceptibilities to 16 other agents. Antimicrob Agents Chemother 1997;41:1033–6.

14.

Brook

Gober

. Emergence of beta-lactamase–producing aerobic and anaerobic bacteria in the oropharynx of children following penicillin chemotherapy. Clin Pediatr (Phila) 1984;23:338–41.

15.

Brook

Gober

. Prophylaxis with amoxicillin or sulfisoxazole for otitis media: Effect on the recovery of penicillin-resistant bacteria from children. Clin Infect Dis 1996;22:143–5.

16.

Howie

. Otitis media. Pediatr Rev 1993;14:320–3.

17.

Marcy

Merril

. Cigarette smoking and respiratory tract infection. Clin Chest Med 1987;8:381–91.

18.

Chen

Qian

C-N

. Epidemiological study of children's health. I. Passive smoking and children's respiratory diseases. Int J Epidemiol 1988;17:348–55.

19.

Sung

Ling

Fung

. Carriage of Haemophilus influenzae and Streptococcus pneumoniae in healthy Chinese and Vietnamese children in Hong Kong. Acta Paediatr 1995;84:1262–7.