Jerome O. Klein

Otitis media and the development of speech and language.

Otitis media is one of the most common infectious diseases of childhood, and many children have many episodes in infancy. Fluid persists in the middle ear for weeks to months after every episode of acute otitis media in spite of apparently appropriate antimicrobial therapy. Persistent or fluctuating hearing loss accompanies middle ear fluid. Children from a high socioeconomic group with recurrent and persistent otitis media in infancy scored lower on tests of speech and language administered at 3 years of age than did their disease-free peers.

Summary: role of a new oral cephalosporin, cefdinir, for therapy of infections of infants and children.

Cefdinir (Omnicef) is a new oral cephalosporin with a broad spectrum of antimicrobial activity, a pleasant taste, a convenient dosage schedule and a favorable adverse event profile. Cefdinir has been available since 1991 in Japan where it is the most frequently used oral cephalosporin. There are 17 antimicrobial agents currently approved for the indication of acute otitis media, and most are also approved for treatment of group A streptococcal pharyngitis and skin infections. How do we assess a new antimicrobial agent when we have so many other drugs that are already available for the same indications? In this supplement the available data about cefdinir, including in vitro activity, pharmacokinetics, safety, palatability and efficacy for acute otitis media and streptococcal pharyngitis are presented. In this report we have summarized those results and presented our conclusions about the role of cefdinir for therapy of infections in infants and children.

Bacteremia in ambulatory children.

Bacteremia is a relatively common event in young, apparently mildly ill febrile children. The bacteremia is associated with certain risk factors including age, elevated temperature and high white blood cell count or increased erythrocyte sedimentation rate. The disease and bacteremia clears without antimicrobial agents in some children, but many untreated children have persistent disease. Culture of blood is valuable in children with risk features and may be enhanced in the future as methods for detection of antigen become more widely available. Available data from randomized trials of therapy do not provide clear guidelines for treatment and opinions about optimal management of children at risk for bacteremia vary. My judgement is that presumptive therapy is warranted for the child who is 6 to 24 months of age, who has high fever and has high white blood cell count. Therapy should be effective for the pneumococcus and for H. influenzae. Currently, I recommend amoxicillin or, for children allergic to penicillin, trimethoprim-sulfamethoxazole or cefaclor. After 48 to 72 hours the physician can judge the clinical course and will have data from cultures to base decisions about management of the illness.