Comparison of amoxicillin administered twice and three times daily in children with acute otitis media

To compare the effectiveness of amoxicillin administered in regimens of two or three daily doses in children with acute otitis media (AOM). As a secondary aim, we measured and compared treatment adherence between the two groups.A prospective observational study was conducted in the emergency department of a children's hospital.We recruited a total of 353 patients having a median age of 1.58 years. Twice-daily dosing was prescribed to 58%, while 42% received three doses per day. The clinical course of AOM was favourable in 92% of the patients who received two doses of amoxicillin and in 95% of those who received three doses (p = 0.25). Four patients (1%) had persistent symptoms beyond day 7. None developed intracranial complications. In the group receiving three doses daily, 31% reported difficulties with the dosing schedule, and 9.6% faced challenges when administering the medication at the specified volume, compared with 5.8% and 25% of those who received the two-dose regimen, respectively.  Conclusion: Twice-daily amoxicillin has similar efficacy to a three-dose daily regimen and can offer advantages for caregivers in terms of administration schedule. What is Known: • Amoxicillin given in two daily doses is as effective as a three doses regimen in the treatment of acute otitis media in children. • The lower the number of daily doses, the higher the adherence to a drug treatment. What is New: • Administration of amoxicillin in twice-daily doses may improve adherence, as it is less frequently associated with family-perceived problems with dosing schedules.

Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study

OBJECTIVE

To determine the incidence and clinical predictors of invasive bacterial infection (IBI) in well-appearing children who present to the emergency department (ED) with fever and petechiae.

DESIGN

A prospective, observational, multicentre study was conducted in 18 hospitals between November 2017 and October 2019.

PATIENTS

A total of 688 patients were recruited.

MAIN OUTCOME MEASURES

The primary outcome was the presence of IBI. Clinical features and laboratory test results were described and related to the presence of IBI.

RESULTS

Ten IBIs were found (1.5%), comprising eight cases of meningococcal disease and two of occult pneumococcal bacteraemia. Median age was 26.2 months (IQR 15.3-51.2). Blood samples were obtained from 575 patients (83.3%). Patients with an IBI had a shorter time from fever to ED visit (13.5 hours vs 24 hours) and between fever and rash onset (3.5 hours vs 24 hours). Values for absolute leucocyte count, total neutrophil count, C reactive protein and procalcitonin were significantly higher in patients with an IBI. Significantly fewer patients with a favourable clinical status while in the observation unit were found to have an IBI (2/408 patients, 0.5%) than when clinical status was unfavourable (3/18, 16.7%).

CONCLUSIONS

The incidence of IBI among children with fever and petechial rash is lower than previously reported (1.5%). The time from fever to ED visit and to rash onset was shorter in patients with an IBI. Patients with a favourable clinical course during observation in the ED are at lower risk of IBI.