Trimethoprim-Sulfamethoxazole in the Treatment of Otitis Media Secondary to Ampicillin-Resistant Strains of Haemophilus Influenzae

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 281-284 ◽  
Author(s):  
Richard Schwartz ◽  
Ronald Mann ◽  
William J. Rodriguez ◽  
Ronald G. Barsanti ◽  
Waheed Khan ◽  
...  
Keyword(s):  
Haemophilus Influenzae ◽  
Minimal Inhibitory Concentration ◽  
Otitis Media ◽  
Middle Ear ◽  
Inhibitory Concentration ◽  
Beta Lactamase ◽  
Type B ◽  
Haemophilus Parainfluenzae ◽  
Resistant Strains

Between August 1977 and January 1979, 16 children (7 males and 9 females) ranging in age from 5 to 38 months (mean age 18 months) were treated with trimethoprim-sulfamethoxazole (TMP-SMX) (40 mg/kg SMX per 24 hours) for otitis media caused by beta-lactamase strains of ampicillin-resistant Haemophilus influenzae. Fourteen patients had failed after antecedent ten-day courses of ampicillin (9 patients) or amoxicillin (5 patients) therapy. The remaining two patients received only five days of ampicillin before changing to TMP-SMX. Six of the isolates were nontypable, 3 were type B, 5 isolates were Haemophilus parainfluenzae, and 2 strains were unavailable for typing. Of 13 strains tested, 10 had a minimal inhibitory concentration (MIC) in excess of 3.12 μg/ml of ampicillin; the remaining 3 had an MIC of < 3.12 μg/ml. All 13 isolates were susceptible to 0.19 μg/ml TMP-SMX. Five of 16 children were symptomatic (irritable; fever of > 38.2 C); within three days of starting TMP-SMX treatment, they became asymptomatic. Fifteen of 16 patients (93%) responded favorably after ten days of TMP-SMX. Only one patient had H influenzae resistant to ampicillin (12.5 μg/ml) and sensitive to TMP-SMX (0.19 μg/ml) isolated from the middle ear at the end of ten days of TMP-SMX. At the end of TMP-SMX therapy, middle ear effusions were noted in ten patients; the fluid was sterile in the four patients who had a second tympanocentesis. There were two recurrences within one month of TMP-SMX therapy. No adverse clinical reactions were noted.

scholarly journals Identification of the Lipooligosaccharide Biosynthesis Gene lic2B as a Putative Virulence Factor in Strains of Nontypeable Haemophilus influenzae That Cause Otitis Media

2002 ◽  
Vol 70 (7) ◽  
pp. 3551-3556 ◽  
Author(s):  
M. M. Pettigrew ◽  
B. Foxman ◽  
C. F. Marrs ◽  
J. R. Gilsdorf
Keyword(s):  
Haemophilus Influenzae ◽  
Otitis Media ◽  
Middle Ear ◽  
Day Care ◽  
Amino Acid Level ◽  
Acute Otitis Media ◽  
Putative Virulence Factor ◽  
Type B ◽  
Nontypeable Haemophilus Influenzae ◽  
Biosynthesis Gene

ABSTRACT Nontypeable (NT) strains of Haemophilus influenzae are an important cause of acute otitis media (OM). The pathogenic process by which NT H. influenzae strains cause OM is poorly understood. In order to identify specific virulence factors important for OM pathogenesis, genomic subtraction of the NT H. influenzae middle ear isolate G622 against H. influenzae strain Rd was conducted and the resulting subtraction products were used to screen a panel of H. influenzae isolates. Subtraction identified 36 PCR fragments unique to strain G622, which were used in a preliminary screen of 48 middle ear isolates and 46 nasopharyngeal and throat isolates to identify genes found more frequently among middle ear isolates. These experiments identified a PCR fragment with high homology to the lipooligosaccharide biosynthesis gene lic2B (originally identified in an H. influenzae type b strain) among 52% of the middle ear isolates and 9% of nasopharyngeal and throat isolates. The lic2B gene cloned from NT H. influenzae strain G622 was 99% identical at the amino acid level to that of the H. influenzae type b strain RM7004. The lic2B gene was used to screen a larger panel of H. influenzae isolates including the original 48 middle ear isolates, 40 invasive type b isolates, 90 NT H. influenzae throat isolates from children attending day care, and 32 NT H. influenzae nasopharyngeal clinical isolates. The lic2B gene was found 3.7 times more frequently among middle ear isolates than in throat isolates from children attending day care. These data suggest that a specific NT H. influenzae gene is associated with OM.

scholarly journals Nontypeable Haemophilus influenzae Gene Expression Induced In Vivo in a Chinchilla Model of Otitis Media

2003 ◽  
Vol 71 (6) ◽  
pp. 3454-3462 ◽  
Author(s):  
Kevin M. Mason ◽  
Robert S. Munson ◽  
Lauren O. Bakaletz
Keyword(s):  
Gene Expression ◽  
Haemophilus Influenzae ◽  
Otitis Media ◽  
Middle Ear ◽  
Fluorescent Protein ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Bacterial Gene ◽  
Nthi Strain

ABSTRACT The gram-negative bacterium nontypeable Haemophilus influenzae (NTHI) is the predominant pathogen in chronic otitis media with effusion and, with Streptococcus pneumoniae and Moraxella catarrhalis, is a causative agent of acute otitis media. To identify potential virulence determinants, bacterial gene expression was monitored by differential fluorescence induction during early disease progression in one specific anatomical niche of a chinchilla model of NTHI-induced otitis media. Genomic DNA fragments from NTHI strain 86-028NP were cloned upstream of the promoterless gfpmut3 gene. NTHI strain 86-028NP served as the host for the promoter trap library. Pools of 2,000 transformants were inoculated into the left and right middle ear cavities of chinchillas. Middle ear effusions were recovered by epitympanic tap at 24 and 48 h, and clones containing promoter elements that were induced in vivo and producing green fluorescent protein were isolated by two-color fluorescence-activated cell sorting. Insert DNA was sequenced and compared to the complete genome sequence of H. influenzae strain Rd. In a screen of 16,000 clones, we have isolated 44 clones that contain unique gene fragments encoding biosynthetic enzymes, metabolic and regulatory proteins, and hypothetical proteins of unknown function. An additional eight clones contain gene fragments unique to our NTHI isolate. Using quantitative reverse transcription-PCR, we have confirmed that 26 clones demonstrated increased gene expression in vivo relative to expression in vitro. These data provide insight into the response of NTHI bacteria as they sense and respond to the middle ear microenvironment during early events of otitis media.

scholarly journals Influence of middle ear alterations on children's balance

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Joana Ferreira ◽  
Carla Matos Silva ◽  
Inês Araújo
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Postural Balance ◽  
Sensory Integration ◽  
Type A ◽  
Clinical Test ◽  
Type B ◽  
Balance Performance ◽  
Balance Disorders

Abstract Background Postural instability is a possible symptom in children with otitis media, which often occurs in this population. The child with balance disorders usually has intolerance to sudden movements, difficulties in moving in the dark, nausea, vomiting and numerous fall events. To verify whether changes in the middle ear can influence the balance postural in children from 3 to 5 years. Methods The sample consisted of 31 children of both sexes, aged between 3 and 5 years. To collect data, a tympanogram was used to analyze the integrity of the tympanic membrane and the Modifid Clinical Test of Sensory Integration and Balance (MCTSIB), with four different sensory conditions, to assess static postural balance. Results Regarding the tympanogram, it was verified that the majority of the sample showed no changes, 45.2% of which were type A and 32.3% of type C1. Regarding the type B and C2 tympanogram, it was found that 12.9% of the sample had type B tympanogram and 9.7% type C2. When comparing these values with the MCTSIB results, there were no significant differences between the tympanogram with changes (B and C2) and the tympanogram without changes (A and C1), regarding the child's balance performance. Conclusions In this study, it was concluded that the alterations of the middle ear, proved through the tympanogram, did not influence the postural balance. However, it was found that the unilateral changes reported by the tympanogram, suggest higher values of postural oscillation, compared to bilateral changes.

Moxalactam Treatment of Serious Infections Primarily Due to Haemophilus influenzae Type b in Children

PEDIATRICS ◽  
1983 ◽  
Vol 71 (2) ◽  
pp. 187-191
Author(s):  
Sheldon L. Kaplan ◽  
Edward O. Mason ◽  
Sally J. Kvernland ◽  
Elaine M. Loiselle ◽  
Ralph D. Feigin
Keyword(s):  
Haemophilus Influenzae ◽  
Adverse Reactions ◽  
Etiologic Agent ◽  
Haemophilus Influenzae Type ◽  
Haemophilus Influenzae Type B ◽  
Type B ◽  
Cns Infections ◽  
Serious Infections ◽  
Resistant Strains ◽  
Transient Elevation

Thirty-eight children completed therapy with moxalactam for a variety of non-CNS infections. Haemophilus influenzae type b (seven ampicillin-resistant strains) was the etiologic agent for 32 children. Doses of moxalactam ranged from 113 to 200 mg/kg/d in three or four divided doses administered parenterally. All children with infections due to H influenzae type b had excellent responses to moxalactam therapy. Children treated for infections due to other agents also responded satisfactorily to moxalactam therapy. Moxalactam concentrations in joint and pleural fluids greatly exceeded the minimal bactericidal concentrations of moxalactam for H influenzae type b. Adverse reactions included neutropenia, eosinophilia, thrombocytosis, and transient elevation of transaminase levels. Moxalactam administered parenterally, at a dose of 113 to 150 mg/kg/d in three or four divided doses is effective therapy for serious infections in children due to H influenzae type b and selected other organisms.

scholarly journals Biofilm Biology and Vaccine Strategies for Otitis Media Due to Nontypeable Haemophilus influenzae

2018 ◽  
Vol 14 (02) ◽  
pp. 069-078 ◽  
Author(s):  
Laura Novotny ◽  
Kenneth Brockman ◽  
Elaine Mokrzan ◽  
Joseph Jurcisek ◽  
Lauren Bakaletz
Keyword(s):  
Haemophilus Influenzae ◽  
Otitis Media ◽  
Middle Ear ◽  
Causative Agent ◽  
Upper Respiratory Tract ◽  
Nontypeable Haemophilus Influenzae ◽  
Physical Defenses ◽  
Upper Respiratory ◽  
Recurrent Nature ◽  
Gain Access

AbstractOtitis media (OM) is one of the most common diseases of childhood, and nontypeable Haemophilus influenzae (NTHI) is the predominant causative agent of chronic and recurrent OM, as well as OM for which treatment has failed. Moreover, NTHI is now as important a causative agent of acute OM as the pneumococcus. NTHI colonizes the human nasopharynx asymptomatically. However, upon perturbation of the innate and physical defenses of the airway by upper respiratory tract viral infection, NTHI can replicate, ascend the Eustachian tube, gain access to the normally sterile middle ear space, and cause disease. Bacterial biofilms within the middle ear, including those formed by NTHI, contribute to the chronic and recurrent nature of this disease. These multicomponent structures are highly resistant to clearance by host defenses and elimination by traditional antimicrobial therapies. Herein, we review several strategies utilized by NTHI to persist within the human host and interventions currently under investigation to prevent and/or resolve NTHI-induced diseases of the middle ear and uppermost airway.

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