CaseRepClinPractRev 2001; 2(1):87-91
In the cool season infections of the ear and throat in children are the most common cause for the visit in general practitioner's or pediatrician's office. The most often encountered pathogens responsible for the infections in the upper respiratory tract are S. pneumoniae, H. influenzae, M. catarrhalis. Tympanocentesis is not routinely performed in cases of otitis, so the etiologic factor is often not known during diagnosis. Prolonged delay in administration of the antibacterial drugs may be the cause of a number of complications. The treatment should be based on the empiric choice of an antibiotic which would cover the most common bacterial pathogens encountered in the paricular disease. It is also crucial to consider the results of the tests concerning bacterial resistance to antibiotics in the given area. Cefaclor is the optimal drug of the first choice in the outpatient, empiric treatment of acute otitis in children. Choice of an antibiotic should be verified after 48 hours. In Poland such treatment is found to be effective in most cases and should be continued for up to 7-10 days. Other groups of drugs with a similar therapeutic spectrum should be considered in cases of poor response or adverse reaction to cefaclor. Bacterial infections make up 10-30% of all cases of pharyngitis. The most common pathogen, covering 90-95% cases, is group A b-hemolytic Streptococcus, for which humans are the only reservoir. Prevention of a rheumatic fever is one of the aims of the therapy in acute pharyngitis of streptococcal etiology. Many different factors should be cosidered before the choice of the apropriate drug, such as clinical efficacy, spectrum of the antibacterial action against the most common pathogens, possible side effects and the ability of a patient to conform to the regime proposed by a physician. Biological availability, eg. due to a better absorbtion of a drug in the upper part of the digestive system, is also important. The antibiotic of the first choice should be chosen on the empiric basis for practical reasons. It shoud be administered in all cases with possible bacterial etiology. Oral penicillin is most effective in streptococcal infections. Basic course of treatment should last 10 days. Poor response to penicillin may reach even 30% in cases of streptococcal pharyngitis. Because of the common colonization with b-lactamase producing co-pathogens, administration of the second generation of cephalosporins, such as Cefaclor, or first generation, eg. Cefadroxin, Cefradine, is recommended. Group A streptococci may be resistant to macrolides, thus these drugs should be very carefully used in streptococcal pharyngitis. Co-trimoxazole and tetracyclines are not enough active against the purulent streptococcus and should not be used in cases of such infection. Ampicillin and amoxicillin should be also avoided in this diagnosis because of the possible presence of bacteria other than streptococci (eg. H. influenzae) or misdiagnosed infectious mononucleosis.
Keywords: Cefaclor, Otitis, Pharyngitis, antibiotic therapy