Clinical and pro-host effects of cefaclor in prophylaxis of recurrent otitis media in HIV-infected children

The aim of this study was to evaluate the efficacy of cefaclor in the prophylaxis of recurrent acute otitis media (AOM) in human immunodeficiency virus (HIV)-infected children. The study was carried out in children born between 1 January 1986 and 31 December 1996 who had been vertically HIV infected Patients who had experienced recurrent AOM between October 1997 and March 1998 (period 1) were eligible for the trial. Recurrent AOM was defined as the occurrence in the same patient of three or more episodes of AOM within 6 months of the observation period. Patients recruited for this trial received cefaclor at a dose of 20 mg/kg once daily for 6 months between April and September 1998 (period 2). Clinical observation was carried out in periods 1 and 2 and for the first 6 months after prophylaxis, i.e. October 1998 - March 1999 (period 3). Natural killer-cell activity, phagocytosis and myeloperoxidase activity were determined before and at the end of the prophylactic period. For each period, CD4-cell count measurement and CD4-positive cell class were recorded. Seventeen children were recruited for this trial. No significant differences were observed in natural killer-cell activity between periods 1 and 2, nor were any significant differences observed in CD4-positive cell class or CD4-positive cell count between the three periods. However, cefaclor administration was associated with a reduction in the number of AOM episodes in 100% of cases and a mean increase in myeloperoxidase activity in 57% of cases. This suggests that cefaclor may be useful in the prophylaxis of recurrent AOM in HIV-infected children.

Comparison of cefaclor and cefuroxime axetil in the treatment of acute otitis media with effusion in children who failed amoxicillin therapy

This trial compared the efficacy and safety of a 10-day treatment course of cefaclor and cefuroxime axetil in the treatment of acute otitis media with effusion in children who failed therapy with amoxicillin. This was an investigator-blind, randomized, parallel treatment group study. To be included, patients must have received treatment with a standard clinical regimen of amoxicillin for at least 48 hours and not more than 10 days, with the last dose within 72 hours of randomization. Patients who met the entry criteria were randomly assigned to one of two antibiotic treatment groups. Cefaclor and cefuroxime axetil suspensions were administered twice daily for a total daily dose of 40 mg/kg and 30 mg/kg, respectively. Physical examination, pneumatic otoscopy and tympanogram were performed to evaluate efficacy to therapy. Therapeutic equivalence was established by ruling out a difference (cefaclor minus cefuroxime axetil) of 15% in percentages of clinical success (cure plus improvement). Safety evaluation was performed by assessment of clinical adverse events. In the intent-to-treat analysis post-therapy (1-6 days after completion of therapy), 96 of 104 (92.3%) cefaclor-treated patients had clinical success compared to 90 of 101 (89.1%) cefuroxime axetil patients. The 95% confidence limits on the difference between proportions of favorable outcomes (cefaclor minus cefuroxime axetil) was from -4.8% to +11.2%. At termination of the study (day 10-16 after completion of therapy), 86 of 104 (82.7%) cefaclor patients and 84 of 101 (83.2%) cefuroxime axetil patients had favorable clinical outcomes (95% confidence interval: -10.8% to +9.9%). Thirty-two (30.8%) of the 104 patients in the cefaclor treatment group reported at least one adverse event, with rhinitis reported in 9 (8.7%) patients and cough increased in 7 (6.7%) patients. Thirty-six (35.6%) of the 101 patients in the cefuroxime axetil treatment group reported at least one event, with diarrhea reported in 11 (10.9%) of patients and rhinitis in 10 (9.9%) patients. Cefaclor and cefuroxime axetil were equally effective in the treatment of patients with acute otitis media with effusion who had failed therapy with amoxicillin. Significantly fewer patients treated with cefaclor reported diarrhea, which is the most frequently reported adverse event in children treated with antibiotics for this disease.