Antibacterials for All AgesNorfloxacin is more efficient than amoxycillin in UTls in the elderly

In a randomised trial involving 37 patients aged 64-91 years, the efficacy of norfloxacin (400mg bid; n = 19)was compared with that of amoxycillin (250mg tid; n = 18) in the treatment of uncomplicated urinary tractinfections. Five patients on amoxycillin were excluded because of isolation of resistant pretreatmentorganisms. The majority of organisms isolated (57%) were strains of Escherichia coli.

Within 9 days of treatment, all 17 patients on norfloxacin and 11 on amoxycillin were cured. However, 6weeks after the end of treatment with norfloxacin 12 patients were cured, 3 were reinfected and there were 2treatment failures. At the same time, 6 amoxycillin-treated patients were cured, 6 were reinfected and therewas 1 treatment failure.

Side effects were few and mild. Emergence of resistance was only a problem with amoxycillin. Thus,norfloxacin was more effective and had a broader antimicrobial action than amoxycillin in the treatment ofuncomplicated urinary tract infections in the elderly.Hill, S; Yeates. M., Pathy, J. and Morgan, J.R.: Journal of Antimicrobial Chemotherapy 15. 505·508 (Apr 1985)

Penicillin + rifampicin is superior to penicillin alone for paediatric tonsillopharyngitisIn a randomised open study the efficacy of oral phenoxymethylpenicillin [penicillin V] was compared with

that of penicillin plus rifampicin in the treatment of children (mean age 8.2 years) with acute group Astreptococcal tonsillopharyngitis. In both groups penicillin was given in a dosage of 80,000 U/kg/day for 10days and in the second group rifampicin 20 mg/kg/day was given on days 7-10. 11 of 39 patients (28%)receiving penicillin alone were treatment failures and 8 were bacteriological and clinical failures. All 40 patientsreceiving penicillin + rifampicin were bacteriologically cured. The difference in cure rates was statistically

significant. The 8 bacteriological and clinical failures, but not the 3 bacteriological failures, were subsequentlycured by a course of penicillin + rifampicin. Eight patients initially cured at the 4- to 7-day follow-up hadpositive cultures 4-6 weeks after starting treatment; 2 were clinically insignificant, 4 were reinfected and 2were relapses.

Although'the combination with rifampicin was clearly superior to penicillin alone in eradicating pharyngealgroup A streptococci, it should not be used routinely since resistance to rifampicin can develop rapidly.Chaudhary, S., Bilinsky, SA.; Hennessy, J.L., Soler, SM.. Wallace, S.E. et ei.: The Journal of Pediatrics 106: 481·486 (Mar 1985)

Amoxycillin + clavulanic acid is impressive in treating paediatric acute otitis mediaIn a randomised single-blind trial involving 150 children aged 0.75-12 years, the efficacy of amoxycillin 12.5

mg/kg + clavulanic acid 3.125 mg/kg tid was compared with that of cefaclor 12.5 mg/kg tid in the treatmentof acute otitis media with effusion. 90 children had unilateral disease and the rest had both ears affected.Demographic data for the 2 groups were comparable, except that more cefaclor-treated children hadStreptococcus pneumoniae as their infecting organism. Treatment lasted 10 days.

Most isolates (60%) were strains of S. pneumoniae or Haemophilus influenzae and all but 10 isolates werehighly susceptible to the 2 test antibacterials. There were no treatment failures associated with amoxycillin +clavulanic acid therapy, whereas 5 children (8%) were not cured after being treated with cefaclor. These 5treatment failures had S. pneumoniae as their infecting organism. One patient from each group relapsedwithin 3 days of treatment ending. From then until 80 days after treatment ended, 13 patients given cefaclorrelapsed compared with 10 given amoxycillin + clavulanic acid. A persistent middle ear effusion occurred in75% of patients by study day 10 but 30 days later this dropped to 45% and by 90 days only 4 of 67 childrenexamined had persistent effusions.

Gastrointestinal upsets were more common with amoxycillin + clavulanic acid (34%) but were mild. Mildneutropenia resulted from treatment with both antibacterials (:::; 10%). Amoxycillin + clavulanic acid waseffective in most cases of acute otitis media with effusion, and should be considered a first-line antibacterialagainst iJ-lactamase producing pathogens.Ooio, C.M., Kusmiesz, H.. Shelton, S. and Nelson, J.D.: Pediatrics 75: 819-826 (May 1985)

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