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MORE EVIDENCE SUPPORTING A SINGLE SHOT OF CEFTRIAXONE FOR AOM.

Treating acute otitis media (AOM) with a single dose of the antibiotic ceftriaxone has been shown to be as effective as a ten-day course of amoxicillin (see JW vol. 11, p. 18; Pediatrics 1993; 91:23). This study compares single-dose ceftriaxone with trimethoprim-sulfamethoxazole (TMP-SMZ), and has similar results.

Researchers enrolled 596 children with AOM, 484 of whom were evaluable: 241 were randomized to ceftriaxone (maximum dose, 50 mg/kg), and 243 to ten days of oral TMP-SMZ. On the third day after treatment, 92.5 percent of the ceftriaxone group, and 95.1 of the TMP-SMZ group, were either cured or improved. On day 14, 80 and 82 percent of the children on ceftriaxone and TMP-SMZ, respectively, were cured. Persistence of middle ear effusion was comparable in both groups on days 14 and 28. There were no serious adverse drug reactions to ceftriaxone, although diarrhea was more commonly reported in the ceftriaxone group.

Comment: Ceftriaxone has a long half-life and broad therapeutic spectrum against the major pathogens that cause AOM, making it an excellent choice for single-dose therapy. Although a comparison with placebo may be desirable, withholding treatment for AOM is considered controversial in the U.S.

— RA Dershewitz

Published in Journal Watch General Medicine January 28, 1997

Citation(s):

Barnett ED et al. Comparison of ceftriaxone and trimethoprim-sulfamethoxazole for acute otitis media. Pediatrics 1997 Jan 99 23-28.

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