ANTIMICROBIAL THERAPY FOR CHILDREN WITH CHRONIC SUPPURATIVE OTITIS-MEDIA WITHOUT CHOLESTEATOMA

This study was designed to determine the middle ear bacterial pathogen s, the frequency of serum immunoglobulin deficiency and the efficacy o f medical management in patients with chronic suppurative otitis media without cholesteatoma. This was an open noncomparative clinical trial performed at the National Children's Hospital, San Jose, Costa Rica, and included 186 patients older than 2 months of age with a confirmed diagnosis of chronic suppurative otitis media without cholesteatoma. M iddle ear cultures and serum for immunoglobulin determinations were ob tained on admission. The first 40 patients were treated only with ceft azidime and from patient 41 and up, if a Grampositive organism was cul tured, oxacillin was added to (for combined infection) or replaced cef tazidime. Parenteral antibiotics and suction twice daily were continue d until three days after the middle ear became dry. Trimethropimsulfam ethoxazole prophylaxis was administered during the follow-up period. M iddle ear bacterial cultures were positive in 166 patients. Pseudomona s sp. (35.6%), enteric Gram-negative organisms (28.7%) and Gram-positi ve cocci (26%) were the most common organisms. Immunoglobulin determin ations were below normal in 3 of 69 (4.3%) evaluable patients. Dryness of the ear was achieved in 174 patients (93.5%) including 130 of 139 patients treated with ceftazidime, 28 of 28 patients treated with oxac illin and 14 of 14 patients treated with ceftazidime and oxacillin. Re current otorrhea developed in 39 (23.4%) patients. Twice-daily canal a spiration and parenteral ceftazidime for Gram-negative organisms and/o r oxacillin for Gram-positive bacteria for 3 days after dryness of the middle ear followed by prophylactic oral antimicrobials are effective for treatment of most chronic suppurative otitis media without choles teatoma patients.