The Ætiology of Chronic Rhinitis and Sinusitis in Children

Effect of amoxicillin or clindamycin on the adenoids bacterial flora

OBJECTIVE: We sought to compare the effect on the adenoid bacterial flora of patients with recurrent otitis media of antimicrobial therapy with amoxicillin (Am) or clindamycin (C).

PATIENTS AND METHODS: Forty-five children scheduled for elective adenoidectomy participated in a prospective randomized study. They were divided into 3 groups of 15 each to receive either no therapy (control) or 10 days of therapy with Am or C. Core adenoid tissues was quantitatively cultured for aerobic and anaerobic bacteria.

RESULTS: Polymicrobial aerobic-anaerobic flora were present in all instances. The predominant aerobes in all groups were α-hemolytic and γ-hemolytic streptococci, Haemophilus influenzae, Staphylococcus aureus, group A β-hemolytic streptococci, and Moraxella catarrhalis. The prominent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium spp. The number of isolates was significantly reduced in those treated with Am (n = 110, P < 0.05) or C (n = 58, P < 0.001) compared with control (n = 148). The number of bacteria per gram/tissue was lower in those treated with either antibiotics. The number of potential pathogens was lower in those treated with C compared with the other 2 groups ( P < 0.001). The number of β-lactamase-producing bacteria was lower in those treated with C than in those treated with Am ( P < 0.025) or control ( P < 0.001).

CONCLUSIONS: These data illustrate the ability of C and, to a lesser degree, of Am to reduce the bacterial load as well as potential pathogens and β-lactamase-producing bacteria from the adenoids of children with recurrent otitis media.

Microbiology of healthy and diseased adenoids

OBJECTIVE

To determine the qualitative and quantitative microbiology of core adenoid tissue obtained from four groups of 15 children each, with recurrent otitis media (ROM), recurrent adenotonsillitis (RAT), obstructive adenoid hypertrophy (OAH), and occlusion or speech abnormalities (controls).

METHODS

Core cultures of surgically removed diseased adenoids and of healthy controls were cultured for aerobic and anaerobic bacteria.

RESULTS

Polymicrobial aerobic-anaerobic flora were present in all instances. Ninety-four organisms were isolated from control specimens, and 148 from ROM, 142 from RAT, and 149 from OAH specimens. The predominant aerobes in all groups were alpha-hemolytic and gamma-hemolytic streptococci, Haemophilus influenzae, Staphylococcus aureus, group A beta-hemolytic streptococci, and Moraxella catarrhalis. The prominent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium species. The number, concentration and distribution of types of most organisms did not vary among the three groups of diseased adenoids. However, the number of those that are potential pathogens and those that produced beta-lactamase was lower in the control than the diseased adenoids (P < .001).

CONCLUSION

The study highlights the importance of the bacterial load in the adenoids in contributing to the etiology of ROM, RAT, and OAH.