Cefaclor in Treatment of Otitis Media and Pharyngitis in Children

Abstract

\s=b\The safety and efficacy of cefaclor were compared with amoxicillin trihydrate in the treatment of 130 cases of otitis media, and with penicillin V potassium in 88 cases of streptococcal pharyngitis in two single-blind controlled studies. Patients with otitis media received approximately 40 mg/kg/day of cefaclor or amoxicillin trihydrate for ten days to three weeks; patients with pharyngitis received 20 mg/kg/day of cefaclor or penicillin V potassium for ten days. Overall, patients who received cefaclor for otitis media had fewer acute failures and better total success, especially in cases caused by Haemophilus influenzae; however, the difference between cefaclor and amoxicillin was not statistically significant. There also was no significant difference between the clinical effectiveness of cefaclor and penicillin in the treatment of streptococcal pharyngitis. Cefaclor was well tolerated with no serious side effects. (Am J Dis Child 134:560-563, 1980) Otitis media and streptococcal pha¬ ryngitis, with their high inci¬ dence and disturbing relapse rates, From the Harrisburg Polyclinic Medical Center, Harrisburg, Pa. Reprint requests to Uptown Medical Building, 2645 N Third St, Harrisburg, PA 17110 (Dr McLinn). are two of the most prevalent infec¬ tions of childhood. Bluestone has termed otitis media with effusion "the most common diagnosis made by physicians who provide care for chil¬ dren (second only to the common cold)."1 Studies from various popula¬ tions have shown that 76% to 95% of all children have at least one episode of otitis media by the age of 6 years.2·3 Of infants in whom middle ear infec¬ tions develop at less than 1 year of age, about one half become otitis prone.4 Permanent structural changes have been reported in as many as 32% of these chronically infected children. Recent literature has shown more insidious complications, such as learn¬ ing disabilities, lowering of intelli¬ gence, and social and language diffi¬ culties as a result of impaired hear¬ ing.58 Antibiotics, principally penicillin and penicillin analogs like ampicillin, have contributed to the reduction of such problems. However, there seems to be an increasing number of reports of the development of ampicillinresistant strains of Haemophilus in¬ fluenzae, both typable and nontypable, which are a major cause of otitis media in young children.914Streptococcal pharyngitis also represents a most common and often persistent bacterial infection in chil¬ dren. The selection of the appropriate antibiotic and compliance with the recommended ten-day dosage regi¬ men may be prophylactic as well as therapeutic, possibly preventing both rheumatic fever (an almost extinct entity in this part of the world today) and acute glomerulonephritis. Howev¬ er, it has been estimated that strepto¬ cocci persist in the pharynx in 10% to 25% of the children who complete a ten-day regimen of penicillin for acute pharyngitis.1516 The high per¬ sistence and recurrence rates have been attributed to one or more of such factors as failure of the patient to com...

Bacteriologic Efficacies of Oral Azithromycin and Oral Cefaclor in Treatment of Acute Otitis Media in Infants and Young Children

“…Furthermore, no significant difference in bacteriologic response rates was found between the isolates for which cefaclor MICs were low (0.38 to 1.0 g/ml) and those for which MICs were higher (1.5 to 3.0 g/ml). The high rate of persistence of H. influenzae in middle-ear fluid after 3 to 4 days of treatment with cefaclor is consistent with the rate reported in other studies (24,34,37): cefaclor had a lower bacteriologic eradication success rate than cefuroxime axetil (14,27), amoxicillin-clavulanate (34,41), cefixime (25,40), and ceftriaxone (27,32).…”

Evidence Assessment of Management of Acute Otitis Media: I. The Role of Antibiotics in Treatment of Uncomplicated Acute Otitis Media

“…There were also no significant differences in the pooled clinical failure rate differences at 3 to 7 days from 4 studies 39,46,49,61 and at 5 to 21 days from 5 studies 39,46,49,56,61 comparing cefaclor with amoxicillin.…”

“…Project staff searched Medline (1966( -March 1999, the Cochrane Library (through March 1999), HealthStar (1975( -March 1999, International Pharmaceutical Abstracts (1970( -March 1999, Cumulative Index to Nursing & Allied Health Literature (1982-March 1999), Biosis (1970( -March 1999, and Embase (1980( -March 1999. We included "gray literature" by reviewing abstracts, reference lists in proceedings, published articles, reports, and guidelines because their exclusion has been shown to be associated with bias in meta-analysis.…”

Anaphylactic Reaction to Oral Cefaclor in a Child

“…Rash and diffuse pruritus were the most common findings. In 1980, McLinn 5 reviewed the efficacy of cefaclor in the treatment of otitis media and noted no serious adverse reactions, except for one case of vascular purpura. This occurred during the sixth day of treatment of a 5-yearold boy with otitis media, who was taking cefaclor, 250 mg, three times a day.…”