Bacteriologic efficacies of oral azithromycin and oral cefaclor in treatment of acute otitis media in infants and young children

A prospective, open-label, randomized study was conducted in order to deter mine the bacteriologic efficacies of cefaclor and azithromycin in acute oti tis media (AOM). Tympanocentesis was performed on entry into the study and 3 to 4 days after initiation of treatment. Bacteriologic failure after 3 to 4 days of treatment with both drugs occurred in a high proportion of cultu re-positive patients, especially in those in whom AOM was caused by Haemoph ilus influenzae (16 of 33 [53%] of those treated with azithromycin and 13 o f 34 [52%] of those treated with cefaclor). Although a clear correlation of the persistence of the pathogen with increased MICs of the respective drug s could be demonstrated for Streptococcus pneumoniae, no such correlation w as found for E-I. influenzae. It is proposed that susceptibility breakpoint s for H. influenzae should be considerably lower than the current ones for both cefaclor and azithromycin for AOM caused by H. influenzae.