Acute Otitis Media (AOM) and Amoxicillin Treatment

Acute otitis media (AOM) is a common childhood ailment often treated with antibiotics, particularly amoxicillin. However, the rise of bacteria producing beta-lactamase, which can render amoxicillin ineffective, has raised concerns about treatment efficacy. AOM is a leading reason for antibiotic prescriptions in children. Beta-lactamase-producing bacteria have become more prevalent and may impact treatment success with amoxicillin, the standard treatment for AOM.

Study Overview

This study was published in the Journal Of The Pediatric Infectious Diseases Society by Holly M Frost and colleagues. This study aimed to evaluate the clinical outcomes of children treated with amoxicillin for AOM and assess whether outcomes vary based on the infecting pathogen or beta-lactamase production.

The study included 205 children aged 6-35 months diagnosed with AOM and prescribed amoxicillin. Bacterial culture and RT-PCR were performed on nasopharyngeal swabs, and parents completed surveys on symptoms, antibiotic adherence, and adverse events. Treatment failure with amoxicillin was the primary outcome, with secondary outcomes including recurrence, symptom improvement, resolution, and adverse events.

Key Findings

• In a study involving 205 children diagnosed with acute otitis media (AOM) and treated with amoxicillin, researchers found that treatment failure with the antibiotic occurred in 5.4% of cases.
• Recurrence of AOM was observed in 6.8% of children.
• By the fifth day of treatment, 74.1% of participants experienced symptom improvement, while 47.3% achieved symptom resolution.
• Adverse drug events were reported by parents for 27.3% of children.
• Common bacterial otopathogens identified included:
  • M. catarrhalis (53.0%)
  • S. pneumoniae (34.2%)
  • H. influenzae (20.1%)
  • S. aureus (14.1%)
• Interestingly, among children who had not previously received amoxicillin treatment, 65.8% tested positive for beta-lactamase-producing bacteria.
• However, treatment failure rates did not differ significantly between children with and without beta-lactamase-producing otopathogens.

Despite concerns about the increasing prevalence of beta-lactamase-producing bacteria, this study found that treatment failure with amoxicillin for AOM in children was uncommon and did not vary based on the infecting pathogen or beta-lactamase production. These findings support current guidance recommending amoxicillin as the preferred treatment for AOM in children, highlighting its continued efficacy in the face of evolving bacterial resistance patterns.

Reference

Frost, H. M., Keith, A., Fletcher, D. R., Sebastian, T., Dominguez, S. R., Kurtz, M., Parker, S. K., Wilson, M. L., & Jenkins, T. C. Clinical outcomes associated with amoxicillin treatment for acute otitis media in children. Journal of the Pediatric Infectious Diseases Society, 2024 iae010. https://doi.org/10.1093/jpids/piae010