BACTERIOLOGICAL RESPONSE TO ORAL CEPHALOSPORINS - ARE ESTABLISHED SUSCEPTIBILITY BREAKPOINTS APPROPRIATE IN THE CASE OF ACUTE OTITIS-MEDIA

Bacteriologic response to cefuroxime axetil and cefaclor administered for 10 days was evaluated in acute otitis media (AOM) in patients aged 6-36 months, Middle ear fluid culture was obtained by tympanocentesis before treatment, on day 4 or 5 after initiation of treatment, and if clinical relapse occurred before day 17. Bacteriologic failure was ob served in 32% of patients receiving cefaclor versus 15% of patients re ceiving cefuroxime axetil (P = .009), Failure rates increased with inc reasing MIC: For Streptococcus pneumoniae, 0.5 mu g/mL (established as cutoff value for cefuroxime by the National Committee for Clinical La boratory Standards [NCCLS]) discriminated between success and failure, For Haemophilus influenzae, high failure rates were observed for cefa clor, even with low MICs (less than or equal to 1.0 mu g/mL), and with both drugs they tended to increase with increasing MIG, even for valu es below the cutoff suggested by the NCCLS (8.0 and 4.0 mu g/mL for ce faclor and cefuroxime, respectively), Thus, for AOM caused by H., infl uenzae, lower susceptibility cutoff levels for MICs should be establis hed.