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Klingmann V, Vallet T, Münch J, Wolters L, Stegemann R, Bosse HM, Ruiz F. Dosage Forms Suitability in Pediatrics: Acceptability of Antibiotics in a German Hospital. Antibiotics (Basel) 2023; 12:1709. [PMID: 38136743 PMCID: PMC10740640 DOI: 10.3390/antibiotics12121709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Although drug acceptability can have a significant impact on patient adherence in pediatric therapy, data are limited, even for common therapeutic areas. We present the second part of an acceptability study conducted at the University Children's Hospital Düsseldorf, Germany. The study investigated the acceptability of most commonly used antibiotics in a pediatric hospital setting. The researchers used the acceptability reference framework to score the acceptability of five antibiotics based on 150 real-life observer reports of medicine intake. Four antibiotics assessed in this study were formulated as preparations for injection (ampicillin, ampicillin/sulbactam, ceftriaxone, and gentamicin) and one as a powder for oral liquid suspension (co-amoxiclav). All the antibiotics formulated as preparations for injection were rated negatively due to high rates of negative reactions (80%), the use of restraint (51%), the use of extra devices (99%), and long preparation and administration times (100%). The antibiotic formulated as a powder was significantly more well accepted. The study concluded that there is a lack of appropriate formulations for antibiotics for use in children. These findings are important in improving knowledge on acceptability drivers and might help in formulating and prescribing better medicines for children. The study highlights the need for healthcare professionals to have knowledge about the acceptability of different products to select the best-adapted product for each patient.
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Affiliation(s)
- Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France; (T.V.); (F.R.)
| | - Juliane Münch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Lena Wolters
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Robin Stegemann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Hans Martin Bosse
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children’s Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; (J.M.); (L.W.); (R.S.); (H.M.B.)
| | - Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France; (T.V.); (F.R.)
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Vallet T, Bensouda Y, Saito J, Mathiesen L, Pokharkar V, Klingmann V, Peak M, Elhamdaoui O, Yamatani A, Ivanovic I, Sajith M, Münch J, Bracken L, Duncan JC, Salunke S, Wang S, Ruiz F. Exploring Acceptability Drivers of Oral Antibiotics in Children: Findings from an International Observational Study. Pharmaceutics 2021; 13:1721. [PMID: 34684014 PMCID: PMC8537532 DOI: 10.3390/pharmaceutics13101721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Antibiotics are among the most commonly prescribed drugs in children. Adherence to the treatment with these drugs is of the utmost importance to prevent the emergence of resistant bacteria, a global health threat. In children, medicine acceptability is likely to have a significant impact on compliance. Herein we used a multivariate approach, considering simultaneously the many aspects of acceptability to explore the drivers of oral antibiotic acceptability in children under twelve, especially in toddlers and in preschoolers. Based on 628 real-life observer reports of the intake of 133 distinct medicines, the acceptability reference framework highlighted the influence of many factors such as age and sex of patients, previous exposure to treatment, place of administration, administration device, flavor agent in excipients and active pharmaceutical ingredient. These findings from an international observational study emphasize the multidimensional nature of acceptability. Therefore, it is crucial to consider all these different aspects for assessing this multi-faceted concept and designing or prescribing a medicine in order to reach adequate acceptability in the target population.
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Affiliation(s)
| | - Yahya Bensouda
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Rabat 10170, Morocco; (Y.B.); (O.E.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Rabat 10170, Morocco
| | - Jumpei Saito
- National Center for Child Health and Development, Tokyo 157-8535, Japan; (J.S.); (A.Y.)
| | - Liv Mathiesen
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, 0316 Oslo, Norway; (L.M.); (I.I.)
| | - Varsha Pokharkar
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune 411038, India; (V.P.); (M.S.)
| | - Viviane Klingmann
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany; (V.K.); (J.M.)
| | - Matthew Peak
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; (M.P.); (L.B.); (J.C.D.)
| | - Omar Elhamdaoui
- Faculty of Pharmacy and Medicine, Mohammed V University in Rabat, Rabat 10170, Morocco; (Y.B.); (O.E.)
- Specialties Hospital, University Medical Centre Ibn Sina (CHIS), Rabat 10170, Morocco
| | - Akimasa Yamatani
- National Center for Child Health and Development, Tokyo 157-8535, Japan; (J.S.); (A.Y.)
| | - Ivana Ivanovic
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, 0316 Oslo, Norway; (L.M.); (I.I.)
| | - Manjusha Sajith
- Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Pune 411038, India; (V.P.); (M.S.)
| | - Juliane Münch
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany; (V.K.); (J.M.)
| | - Louise Bracken
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; (M.P.); (L.B.); (J.C.D.)
| | - Jennifer Claire Duncan
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK; (M.P.); (L.B.); (J.C.D.)
| | - Smita Salunke
- Department of Pharmaceutics, University College London School of Pharmacy, London WC1N 1AX, UK;
| | - Siri Wang
- Norwegian Medicines Agency, 0213 Oslo, Norway;
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Mistry P, Stirling H, Callens C, Hodson J, Batchelor H. Evaluation of patient-reported outcome measurements as a reliable tool to measure acceptability of the taste of paediatric medicines in an inpatient paediatric population. BMJ Open 2018; 8:e021961. [PMID: 29997143 PMCID: PMC6082459 DOI: 10.1136/bmjopen-2018-021961] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the age appropriateness and suitability of patient-reported outcome measures to assess the acceptability of the taste of oral liquid medicines in children. DESIGN AND SETTING An observational mixed-methods study involving children aged 2-16 years taking oral liquid medicine in paediatric inpatient wards across the West Midlands (UK). Assessment tools included patient-reported scores on the taste of medicines via a five-point Facial Hedonic Scale; a Visual Analogue Scale (VAS); a question, 'Did you think the medicine tasted OK?' and researcher observations of facial expressions and behaviours immediately before, during and after administration. RESULTS 611 children participated. The percent unable to complete the scales was 7% (n=46) for the VAS; 2% (n=15) for the hedonic scale and 1% (n=7) for the question about taste. Significant correlations (Spearman's r) were observed between the patient-reported outcome measures: 0.80 and 0.78 for the taste question and hedonic and VAS, respectively, and 0.84 for the hedonic and VAS. Researcher observations demonstrated the ability of the patient to take the medicine as intended but did not provide sensitive measures of taste. 5% of administrations were not taken as intended by the children. Medicines known to have poor taste (clarithromycin and prednisolone) showed mean hedonic and VAS scores of ≥3.5 and >65 mm, respectively. CONCLUSIONS Patient-reported outcome measures correlate with each other and are a useful means to assess the taste (and acceptability) of medicines. Hedonic scales are better understood by children and should be the first choice tool in the assessment of medicines taste.
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Affiliation(s)
- Punam Mistry
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Heather Stirling
- Paediatrics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Claire Callens
- NIHR Clinical Research Network West Midlands, Institute of Research and Development, Birmingham, UK
| | - James Hodson
- Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Hannah Batchelor
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Methodology Used to Assess Acceptability of Oral Pediatric Medicines: A Systematic Literature Search and Narrative Review. Paediatr Drugs 2017; 19:223-233. [PMID: 28413843 DOI: 10.1007/s40272-017-0223-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Regulatory guidelines require that any new medicine designed for a pediatric population must be demonstrated as being acceptable to that population. There is currently no guidance on how to conduct or report on acceptability testing. AIM Our objective was to undertake a review of the methods used to assess the acceptability of medicines within a pediatric population and use this review to propose the most appropriate methodology. METHODS We used a defined search strategy to identify literature reports of acceptability assessments of medicines conducted within pediatric populations and extracted information about the tools used in these studies for comparison across studies. RESULTS In total, 61 articles were included in the analysis. Palatability was the most common (54/61) attribute measured when evaluating acceptability. Simple scale methods were most commonly used, with visual analog scales (VAS) and hedonic scales used both separately and in combination in 34 of the 61 studies. Hedonic scales alone were used in 14 studies and VAS alone in just five studies. Other tools included Likert scales; forced choice or preference; surveys or questionnaires; observations of facial expressions during administration, ease of swallowing, or ability to swallow the dosage; prevalence of complaints or refusal to take the medicine; and time taken for a nurse to administer the medicine. CONCLUSIONS The best scale in terms of validity, reliability, feasibility, and preference to use when assessing acceptability remains unclear. Further work is required to select the most appropriate method to justify whether a medicine is acceptable to a pediatric population.
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Bluestone CD, Klein JO, Rosenfeld RM, Berman S, Casselbrant ML, Chonmaitree T, Giebink GS, Grote JJ, Ingvarsson LB, Linder T, Lous J, Maw AR, Paradise JL, Sando I, Stool SE, Takasaka T. 9. Treatment, Complications, and Sequelae. Ann Otol Rhinol Laryngol 2016. [DOI: 10.1177/00034894021110s312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kuehn J, Ismael Z, Long PF, Barker CI, Sharland M. Reported rates of diarrhea following oral penicillin therapy in pediatric clinical trials. J Pediatr Pharmacol Ther 2015; 20:90-104. [PMID: 25964726 PMCID: PMC4418686 DOI: 10.5863/1551-6776-20.2.90] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Antibiotic-associated diarrhea (AAD) is a well-recognized adverse reaction to oral penicillins. This review analyzed the literature to determine the incidence of AAD following amoxicillin, amoxicillin/clavulanate, and penicillin V oral therapy in pediatric clinical trials. METHODS An advanced search was conducted in MEDLINE and Embase databases for articles in any language reporting the incidence of AAD following oral penicillin therapy for any indicated infection in children (0-17 years). The search was limited to clinical trials. Articles were excluded if treatment was related to chronic conditions, involved concomitant antimicrobials, or if the dose or number of patients was not specified. RESULTS Four hundred thirty-five articles relating to clinical trials were identified (307 from Embase; 128 from MEDLINE). Thirty-five articles reporting on 42 studies were included for analysis. The indications included acute otitis media, sinusitis, pharyngitis, and pneumonia. Thirty-three trials reported on amoxicillin/clavulanate, 6 on amoxicillin, and 3 on penicillin V. In total, the 42 trials included 7729 children who were treated with an oral penicillin. On average, 17.2% had AAD. Data were pooled for each penicillin. The AAD incidence was 19.8% for amoxicillin/clavulanate, 8.1% for amoxicillin, and 1.2% for penicillin V. The amoxicillin/clavulanate data were analyzed according to formulation: pooled-average. The incidence of ADD was 24.6% for the 4:1 formulation, 12.8% for the 7:1 formulation, 19.0% for the 8:1 formulation, and 20.2% for the 14:1 formulation. CONCLUSIONS These results demonstrate substantially increased incidence of AAD following use of amoxicillin/clavulanate, compared to use of amoxicillin and penicillin V, as well as varying AAD rates with diffierent amoxicillin/clavulanate formulations. These findings warrant consideration when prescribing. The underlying mechanisms of AAD in children remain unclear.
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Affiliation(s)
- Jemima Kuehn
- Paediatric Infectious Diseases Unit, St George's Hospital, London, United Kingdom
- Cook County-Loyola-Provident Family Medicine Residency Program, Chicago, Illinois
| | - Zareen Ismael
- Institute of Pharmaceutical Science & Department of Chemistry, King's College, University of London, London, United Kingdom
| | - Paul F. Long
- Institute of Pharmaceutical Science & Department of Chemistry, King's College, University of London, London, United Kingdom
| | - Charlotte I.S. Barker
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
| | - Mike Sharland
- Paediatric Infectious Diseases Unit, St George's Hospital, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
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Compliance with once-daily versus twice or thrice-daily administration of antibiotic regimens: a meta-analysis of randomized controlled trials. PLoS One 2015; 10:e0116207. [PMID: 25559848 PMCID: PMC4283966 DOI: 10.1371/journal.pone.0116207] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/05/2014] [Indexed: 02/08/2023] Open
Abstract
Objective To investigate whether compliance of patients to antibiotic treatment is better when antibiotics are administered once than multiple times daily. Methods We performed a systematic search in PubMed and Scopus databases. Only randomized controlled trials were considered eligible for inclusion. Compliance to antibiotic treatment was the outcome of the meta-analysis. Results Twenty-six studies including 8246 patients with upper respiratory tract infections in the vast majority met the inclusion criteria. In total, higher compliance was found among patients treated with once-daily treatment than those receiving treatment twice, thrice or four times daily [5011 patients, RR=1.22 (95% CI, 1.11, 1.34]. Adults receiving an antibiotic once-daily were more compliant than those receiving the same antibiotic multiple times daily [380 patients, RR=1.09 (95% CI, 1.02, 1.16)]. Likewise, children that received an antibiotic twice-daily were more compliant than those receiving the same antibiotic thrice-daily [2118 patients, RR=1.10 (95% CI, 1.02, 1.19)]. Higher compliance was also found among patients receiving an antibiotic once compared to those receiving an antibiotic of different class thrice or four times daily [395 patients, RR=1.20 (95% CI, 1.12, 1.28)]. The finding of better compliance with lower frequency daily was consistent regardless of the study design, and treatment duration. Conclusion This meta-analysis showed that compliance to antibiotic treatment might be associated with higher when an antibiotic is administered once than multiple times daily for the treatment of specific infections and for specific classes of antibiotics.
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Lode H. Safety and tolerability of commonly prescribed oral antibiotics for the treatment of respiratory tract infections. Am J Med 2010; 123:S26-38. [PMID: 20350633 DOI: 10.1016/j.amjmed.2010.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recent data suggest that adverse events (AEs) associated with the use of antimicrobial drugs are a major safety concern, with antibiotics implicated in a significant proportion (approximately 20%) of all drug-related emergency department visits in the United States. Although most of these visits are attributable to allergic reactions (79%), certain commonly prescribed antibiotics are notable contributors to conditions that range in nature from gastrointestinal to neurologic and/or psychiatric--particularly after ED visits are adjusted per outpatient prescription visits. This article reviews medically significant AEs of agents included in the major antimicrobial classes--AEs that may be underappreciated by general practitioners. Considerable attention is devoted to the fluoroquinolone agents. Also discussed are the assessment procedures of regulatory agencies in Europe and the United States that are in place to evaluate antimicrobial safety more accurately. Offsetting potential risks and benefits associated with currently available antimicrobials in a climate in which new agents are desperately needed to combat continually evolving multiresistant pathogens remains an interesting dilemma in antimicrobial therapy.
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Affiliation(s)
- Hartmut Lode
- City Hospital Berlin-Zehlendorf, Free University of Berlin, Berlin, Germany.
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Davies EH, Tuleu C. Medicines for children: a matter of taste. J Pediatr 2008; 153:599-604, 604.e1-2. [PMID: 18940350 DOI: 10.1016/j.jpeds.2008.06.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 04/29/2008] [Accepted: 06/18/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Elin Haf Davies
- Medicines for Children SENCE Local Research Network, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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Pichichero ME, Casey JR. Comparison of study designs for acute otitis media trials. Int J Pediatr Otorhinolaryngol 2008; 72:737-50. [PMID: 18400312 DOI: 10.1016/j.ijporl.2008.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 02/22/2008] [Accepted: 02/26/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND A framework for evaluating the efficacy of antibiotics in development as well as those currently approved for acute otitis media (AOM) is needed. OBJECTIVE Review strengths and limitations of various antibiotic trial designs and their outcome measures. METHODS A review of 157 published trials involving 36,710 subjects for the treatment of AOM. RESULTS AOM trials have three designs: (1) clinical, clinical diagnosis and assessment of outcomes; (2) single tympanocentesis, microbiologic diagnosis (by middle ear fluid culture) and clinical assessment of outcomes; and (3) double tympanocentesis, microbiologic diagnosis and microbiologic outcome assessment. Identifiable strengths and limitations of each design are reviewed. Case definitions for entry of children in trials of AOM vary widely. The lack of stringent diagnostic criteria in a clinical design allows for inclusion of a significant proportion of children with a non-bacterial etiology (i.e., viral AOM or otitis media with effusion). Tympanocentesis increases diagnostic accuracy at study entry; however, the procedure is confounding because of its potentially therapeutic benefit and the procedure is not performed in a uniform manner. A second tympanocentesis allows a high sensitivity to detect microbiologic eradication, but it does not correlate with clinical outcomes in half of the cases. The timing of outcome assessment also varies widely among trials. CONCLUSIONS Improved clinical diagnosis criteria for AOM are needed to enhance specificity; emphasis on a bulging tympanic membrane has the best evidence base. Tympanocentesis within study designs has merits. At study entry it assures diagnostic accuracy but may alter outcomes and it is useful to document microbiologic outcomes but lacks specificity for clinical outcomes. For all designs, test of cure assessment 2-7 days after completion of therapy seems most appropriate.
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Affiliation(s)
- Michael E Pichichero
- University of Rochester, School of Medicine, Department of Microbiology/Immunology, 601 Elmwood Avenue, Box 672, Rochester, NY 14642, United States.
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Block SL, Doern GV, Pfaller MA. Oral β-lactams in the treatment of acute otitis media. Diagn Microbiol Infect Dis 2007; 57:19S-30S. [PMID: 17349460 DOI: 10.1016/j.diagmicrobio.2007.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 01/17/2007] [Indexed: 11/29/2022]
Abstract
Acute otitis media (AOM) is an important infectious disease among children throughout the world. The management of AOM is complicated by difficulties in diagnosis, spontaneous resolution, altered microbiology after pneumococcal conjugate vaccine use, and expanding antimicrobial resistance. The recent introduction of the heptavalent pneumococcal vaccine has resulted in a decrease in AOM due to penicillin-nonsusceptible strains of Streptococcus pneumoniae (PNSP) and an increase in infection due to beta-lactamase-positive nontypeable Haemophilus influenzae. The results of in vitro susceptibility testing in the context of broad surveillance programs provide useful information regarding the potency and spectrum of the oral beta-lactam antibacterial agents used in the treatment of AOM. The application of pharmacokinetic/pharmacodynamic breakpoints provides an effective means of projecting the potential clinical efficacy of the available agents. In view of what appears to be an increase prominence of beta-lactamase-positive Gram-negative AOM pathogens and a decrease in PNSP, it appears that empiric therapy for AOM should now include an agent with activity against beta-lactamase-positive H. influenzae and S. pneumoniae.
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Affiliation(s)
- Stan L Block
- Kentucky Pediatric/Adult Research, Bardstown, KY, USA
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Chandler SM, Garcia SMS, McCormick DP. Consistency of diagnostic criteria for acute otitis media: a review of the recent literature. Clin Pediatr (Phila) 2007; 46:99-108. [PMID: 17325082 DOI: 10.1177/0009922806297163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Clinicians use various criteria to diagnose acute otitis media (AOM). Using American Academy of Pediatrics (AAP) guidelines, we reviewed the consistency of AOM diagnosis in clinical trials (1994-2005). Eighty-one percent of the studies required at least one of the three AAP criteria. Only 20% of the 88 studies met all three AAP criteria for a diagnosis. We found no association between the number of criteria met and study quality or industry sponsorship. Better agreement on the definition of AOM using AAP criteria could facilitate a more accurate clinical diagnosis and provide standardization of research and patient care practices.
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Affiliation(s)
- Stephanie M Chandler
- University of Texas Medical Branch, 400 Harbourside Drive, Galveston, TX 77555, USA
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Mitropoulos IF, Rotschafer JC, Rodvold KA. Adverse events associated with the use of oral cephalosporins/cephems. Diagn Microbiol Infect Dis 2007; 57:67S-76S. [PMID: 17292575 DOI: 10.1016/j.diagmicrobio.2006.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 12/04/2006] [Indexed: 01/11/2023]
Abstract
Historically, oral cephalosporins represent one of the most widely used and safest classes of antimicrobials available. Typical adverse events have included nausea, vomiting, diarrhea, and hypersensitivity reactions. Other more serious events such as pseudomembranous colitis, although infrequent, may occur. The exact type and incidence of adverse events varies depending on the cephalosporin being administered. Differences in adverse event profiles may also vary by age of the patient. Reactions are usually not severe and often do not require termination of therapy. The purpose of this review is to present to healthcare providers the historical safety profile of the most commonly used oral cephalosporins.
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Appelbaum PC. Are cephalosporins appropriate for the treatment of acute otitis media in this era of increasing antimicrobial resistance among common respiratory tract pathogens? Clin Pediatr (Phila) 2005; 44:95-107. [PMID: 15735827 DOI: 10.1177/000992280504400201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Peter C Appelbaum
- Division of Clinical Pathology, Medical Director, Clinical Microbiology, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA
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Verhoef J, Gillissen A. Resistant Haemophilus influenzae in community-acquired respiratory tract infections: a role for cefixime. Int J Antimicrob Agents 2003; 21:501-9. [PMID: 12791462 DOI: 10.1016/s0924-8579(03)00095-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An increase in Haemophilus influenzae resistance has been documented around the world during the last 30 years. Resistance is due to the production of beta-lactamases, and/or changes to penicillin-binding protein (PBP) targets. The resistance problem has led to the need for new therapeutic strategies aimed at maintaining effective management of both upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs). Among antimicrobial agents tested, third-generation cephalosporins have been shown to possess excellent in vitro activity against beta-lactamase-positive and -negative isolates, corresponding with proven clinical efficacy in a wide range of RTIs. The role of H. influenzae in RTIs is outlined, changing trends in epidemiological surveillance studies monitored and implications for therapy, based upon results of clinical trials discussed.
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Affiliation(s)
- Jan Verhoef
- Eijkman-Winkler Institute of Medical and Clinical Microbiology, University Medical Center, Utrecht, Netherlands.
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Abstract
BACKGROUND There have been few controlled studies evaluating treatment of bacterial conjunctivitis beyond the newborn period. Topical therapy of bacterial conjunctivitis achieves a clinical cure but does not prevent acute otitis media (AOM). OBJECTIVES The aim of this study was to compare systemic antibiotic therapy (cefixime) with topical therapy with polymyxin-bacitracin for treatment of acute bacterial conjunctivitis with regard to clinical and bacteriologic cure and prevention of AOM. METHODS This study was a randomized, double blind, placebo-controlled trial of polymyxin-bacitracin ointment and oral placebo vs. topical placebo and oral cefixime in children with presumed acute bacterial conjunctivitis. Topical therapy was administered for 7 days; oral therapy was administered for 3 days. Bacterial cultures were obtained at entry and on Day 3 of treatment. Children were examined on Days 3 and 10 or if they worsened within 15 days of entry. RESULTS Eighty children were enrolled in the study. Bacterial cultures of the conjunctiva were positive in 70% of children: Haemophilus influenzae (53.7%); Streptococcus pneumoniae (13.8%); H. influenzae and S. pneumoniae (1.2%); and Moraxella catarrhalis (1.3%). There were 7 (17.5%) bacteriologic failures among children receiving topical antibiotic and oral placebo and 15 (37.5%) bacteriologic failures among children receiving topical placebo and oral cefixime (P = 0.07 with Yates correction). There was no difference between study groups with regard to either clinical cure or the development of AOM. Nine children (11%), 5 who received active topical therapy and 4 who received active oral drug, developed AOM either during or within 15 days of study entry. CONCLUSION Cefixime was not more effective than topical polymyxin-bacitracin in either the eradication of conjunctival colonization with respiratory pathogens or the prevention of AOM in children with acute bacterial conjunctivitis.
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Affiliation(s)
- E R Wald
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, PA 15213, USA.
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de Lalla F. Oral cephalosporins in airway infections. Clin Microbiol Infect 2001; 6 Suppl 3:70-2. [PMID: 11449658 DOI: 10.1111/j.1469-0691.2000.tb02048.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- F de Lalla
- Department of Infectious Diseases, S. Bortolo Hospital, Vicenza, Italy
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Subba Rao SD, Macias MP, Dillman CA, Ramos BD, Kierszenbaum JS, Soliman AE. A randomized, observer-blind trial of amoxycillin/clavulanate versus cefaclor in the treatment of children with acute otitis media. Augmentin 415 Study Group. J Chemother 1998; 10:460-8. [PMID: 9876054 DOI: 10.1179/joc.1998.10.6.460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In this randomized, multicenter, observer-blind study, the efficacy, safety and tolerability of amoxycillin/clavulanate and cefaclor were compared in children with a clinical diagnosis of acute otitis media. Patients aged between 1 and 12 years received either amoxycillin/clavulanate (250 mg/62 mg t.i.d., or 125 mg/31 mg t.i.d. if aged under 6 years) or cefaclor (250 mg t.i.d., or 125 mg t.i.d. if aged under 6 years) for 7 days. The amoxycillin/clavulanate regimen was based on a dose of 20/5 mg/kg/day (representing 20 mg amoxycillin plus 5 mg clavulanic acid) in three divided doses. Patients were followed-up at the end of therapy and on days 10-12 and 38-40. At the end of the study (days 38-40), clinical success rates were 91.4% for amoxycillin/clavulanate and 78.6% for cefaclor. The difference was statistically significant (p = 0.008). After the 7 days of treatment, 3 patients (2.9%) in the amoxycillin/clavulanate group had clinical failure, compared with 18 patients (16.1%) in the cefaclor group (p < 0.001). Both treatments were well tolerated and there were no statistically significant differences between the groups in adverse event profiles. The incidence of diarrhea was low (7.0% amoxycillin/clavulanate, 8.4% cefaclor) and was generally of mild or moderate intensity. The study demonstrated that amoxycillin/clavulanate was significantly more effective clinically than cefaclor in the treatment of acute otitis media in children.
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Affiliation(s)
- S D Subba Rao
- St. John's Medical College Hospital, Bangalore, India
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