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Management of Acute Otitis Media

Defining the Role of Cefuroxime Axetil

  • Drugs in Disease Management
  • Published:
Disease Management and Health Outcomes

Abstract

Growing concern about the rapid emergence of penicillin-resistant Streptococcus pneumoniae, as well as β-lactamase-mediated resistance among Haemophilus influenzae and Moraxella catarrhalis, has lead to reconsideration of the management of acute Otitis media in children. Acute Otitis media is the most common disorder diagnosed by paediatricians and among the most common indications for which antibacterial agents are prescribed in children.

Although there is little consensus regarding the optimal management of children with acute Otitis media, the need for judicious use of antibacterial agents is generally recognised. Several initiatives have been undertaken in an attempt to improve the management practices for this infection. One recent example is the recommendations of the US Drug-Resistant S. pneumoniae (DRSP) Therapeutic Working Group which advocate an accurate diagnosis of acute Otitis media, a step-wise approach to treatment and a role for diagnostic tympanocentesis in children who do not respond to therapy. Based on pharmacokinetic and efficacy data, amoxicillin is recommended as first-line treatment. Cefuroxime axetil, amoxicillin/clavulanic acid and ceftriaxone are recommended as second-line options.

Conclusions: Cefuroxime axetil is one of very few oral agents which has proven clinical efficacy against S. pneumoniae, as well as β-lactamase-producing H. influenzae and M. catarrhalis. Although not as palatable as some other oral paediatric formulations, it has significantly better gastrointestinal tolerability than amoxicillin/clavulanic acid, another oral agent with a similar activity profile, and can be administered conveniently in 2 divided daily doses. Cefuroxime axetil is, therefore, an important oral treatment option for children with acute otitis media.

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    Harriet M. Lamb & Caroline M. Spencer

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Additional information

Various sections of the manuscript reviewed by: R. Alsarraf, Hedgewood Surgical Center, New Orleans, Louisiana, USA; A. Bitnun, Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada; P. Gehanno, Service d’Oto-Rhino-Laryngologie, Hôpital Bichat-Claude Bernard, Paris, France; J.J. Pessey, Hôpital de Rangueil, Toulouse, France; M.E. Pichichero, University of Rochester Medical Center, Microbiology/Immunology, Rochester, New York, USA; E. Thoroddsen, Medical Clinic, Reykjavik, Iceland.

Data Selection

Sources: Medical literature published in any language since 1966 on cefuroxime axetil, identified using Medline supplemented by AdisBase (a proprietary database of Adis International, Auckland, New Zealand). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.

Search strategy: AdisBase search terms were ‘otitis-media’ and (‘guideline’ or ‘guideline-utilisation’ or ‘practice-guideline’ or ‘disease-management-programmes’ or ‘treatment-algorithms’ or ‘reviews-on-treatment’ or ‘drug-evaluations’ or ‘epidemiology’ or ‘cost-of-illness’ or ‘pathogenesis’), or ‘cefuroxime-axetil’ and (‘review’ or ‘clinical-study’). Medline search terms were ‘otitis media’ and (‘guidelines’ or ‘decision-making’ or ‘health-policy’ or ‘managed-care-programmes’ or ‘epidemiology’ or ‘outcome-assessment-health-care’ or ‘clinical-protocols’ or ‘guideline in pt’ or ‘practice-guideline in pt’), or ‘cefuroxime-axetil’ and ‘review in pt’. Searches were last updated 24 November 2000.

Selection: Studies in patients with otitis media who received cefuroxime axetil. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic, pharmacokinetic, epidemiological and cost data are also included.

Index terms: cefuroxime axetil, otitis media, antibacterial activity, therapeutic use, pharmacokinetics, disease management, children, review on treatment.

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Lamb, H.M., Spencer, C.M. Management of Acute Otitis Media. Dis-Manage-Health-Outcomes 8, 337–353 (2000). https://doi.org/10.2165/00115677-200008060-00004

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