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  • Title: The effects of treatment of acute otitis media with a low dose vs a high dose of amoxicillin on the nasopharyngeal flora.
    Author: Brook I, Gober AE.
    Journal: Arch Otolaryngol Head Neck Surg; 2009 May; 135(5):458-61. PubMed ID: 19451466.
    Abstract:
    OBJECTIVE: To compare the effects on the nasopharyngeal flora of therapy of acute otitis media in children with either a low dose or a high dose of amoxicillin. DESIGN: Retrospective study. PATIENTS: Of 50 children diagnosed as having acute otitis media, 25 received a low dose of amoxicillin (45 mg/kg/d) (group 1) and 25 received a high dose of amoxicillin (90 mg/kg/d) (group 2) for 10 days, and both groups were evaluated. INTERVENTION: Antimicrobial treatment. RESULTS: Before therapy, potential pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus) were isolated from the nasopharynx of 15 children in group 1 (60%) and 13 in group 2 (52%). The number of penicillin-susceptible isolates was equally reduced after both therapies. However, an increase was noted in the recovery of S aureus only in group 2 (from 2 to 6 organisms). A greater eradication rate of interfering organisms following therapy was noted in group 2 (from 86 to 36) than in group 1 (from 92 to 60) (P < .001). These organisms include alpha-hemolytic streptococci, and Peptostreptococcus and Prevotella species. CONCLUSIONS: The oral flora at the end of therapy with a high dose of amoxicillin is more depleted of organisms with interfering capability than following treatment with a low dose of amoxicillin. These changes may contribute to the greater recovery rate of patients infected with S aureus who received a high dose of amoxicillin.
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