Possibility of weekly azithromycin treatment in children with persistent AOM

January 01, 0001

Possibility of weekly azithromycin treatment in children with persistent AOM

The aim of this study by Australian researchers was to compare the clinical effectiveness of single-dose azithromycin treatment with 7 days of amoxycillin treatment among Aboriginal children with acute otitis media (AOM) in rural and remote communities in the Northern Territory. Aboriginal children aged 6 months to 6 years living in 16 rural and remote communities were screened for AOM. Those diagnosed with AOM were randomly allocated to receive either azithromycin (30 mg/kg as a single dose) or amoxycillin (50mg/kg/day in two divided doses for a minimum of 7 days). They used a double-dummy method to ensure blinding. They followed 306 of 320 children (96%) allocated to the treatment groups.

Single-dose azithromycin did not reduce (or increase) the risk of clinical failure (50% failure rate 82/165) compared with amoxycillin (54% failure rate 83/155) (risk difference, RD - 4%). Compared with amoxycillin, azithromycin significantly reduced the proportion of children with nasal carriage of S. pneumoniae (27% v 63%; RD - 36%) and noncapsular Hemophilus influenza (NCHi) (55% v 85%, RD - 30%). Nasal carriage of S. pneumoniae with intermediate or full resistance to penicillin was lower (but not significantly so) in the azithromycin group (10% v 16%), but this group had significantly increased carriage of azithromycin-resistant S. pneumoniae (10% v 3%, RD 7% ). Carriage of beta-lactamase-producing NCHi was about 5% in both groups.

The authors concluded: “Although azithromycin reduced nasal carriage of S. pneumoniae and NCHi, clinical failure was high in both treatment groups. The possibility of weekly azithromycin treatment in children with persistent AOM should be evaluated.”

Resistance may be of concern in the long run, but the idea in the last sentence is worth considering and researching.

For the full abstract, click here.

MJA 192 (1):24-29, 4 January 2010. © 2010 to The Medical Journal of Australia
Single-dose azithromycin versus seven days of amoxycillin in the treatment of acute otitis media in Aboriginal children (AATAAC)-a double blind, randomised controlled trial. Peter S Morris, Gaudencio Gadil, Gabrielle B McCallum, et al. Correspondence to Dr. Amanda Leach: [email protected]

Category: H. Ear. Keywords: azithromycin, single dose, amoxycillin, acute otitis media, aboriginal, children, double blind randomised controlled trial
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 13 January 2010

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