Efficacy of Cefuroxime and Amoxicillin in Otitis Media Treatment among Children

Running head: THEMWESH
TheMwesh
Name of the Student
Name of the University
Author note

1THEMWESH
Table of Contents
1. Rationale...................................................................................................................................2
2. Research question.....................................................................................................................4
3. Search Strategy.........................................................................................................................5
Research design...........................................................................................................................5
Search strategy and bibliographic aids........................................................................................6
Data collection and analysis........................................................................................................6
Keywords.....................................................................................................................................7
Inclusion and exclusion criteria...................................................................................................7
Search outcomes..........................................................................................................................8
PRISMA flow diagram..............................................................................................................10
Limitations of the study.............................................................................................................11
4. Main findings.........................................................................................................................11
5. Recommendations..................................................................................................................14

2THEMWESH
1. Rationale
Otitis media is referred as middle ear infection where there is building up of fluid in the
middle ear. It is also known as childhood illness that is common among this age group having
symptoms like fever and earache. Acute Otitis media occurs in children between ages 6 to 18
months up to 4 years of age. More than 65% of infections occur in children at least once by the
age of 3 years. Children complain of ear pain that are diagnosed with Otitis media having
symptoms including restlessness, irritability, fever and disrupted sleep. The eardrum ruptures and
there is discharge from the affected ear. Viral or bacterial infection is the greatest risk factor for
Otitis media among children. According to (1) Otitis media occurs in majority of children below
the age of six years with high prevalence in developing countries posing a significant burden of
disease in these settings. It is a major cause of morbidity and a frequent reason for antibiotic
administration among children. A large cross-sectional survey conducted by (2) depicted the fact
that Otitis media is a major concern and burden in clinical practice and empirical treatment with
antibiotics is considered the first line of treatment (3). Therefore, the rationale for choosing this
topic is that Otitis media has emerged as a common medical problem among paediatricians,
caregivers and for the children who visit doctors regularly with this condition. As a result, the
normal routine is disrupted where adequate treatment is not provided to them on time that fails to
provide relief to the children from pain and discomfort. Long-term sequelae can result in
permanent middle ear damage or hearing loss in children that need to be lessened with
appropriate antibacterial treatment.

3THEMWESH
Antibiotics are prescribed to the children diagnosed with Otitis media; however, they
develop resistance causing a failure in first line medicines. The recommended first line of
therapy in Otitis media is high-dosage amoxicillin (80 to 90 mg per kg per day), however
children develop resistance or if the child is having a history of hypersensitivity to penicillin or
amoxicillin. There is recent antibiotic pressure and pneumococcal conjugate vaccine due to the
emergence of Haemophilus influenza (beta-lactamase production). The current Academy of
Pediatrics endorse that amoxicillin is the preferred medication for Otitis media treatment,
however with increasing amoxicillin-resistant H influenza, it is not considered preferred
treatment (4).There is increase in isolates with beta-lactamase producing capability and this
resulted in decreased efficacy of amoxicillin with greater stability for Otitis media treatment.
Considering this situation, some studies supported the fact that Cefuroxime, a second-generation
medicine is effective in resolving Otitis media in cases where children develop amoxicillin
resistance (5).
There is an ongoing debate between the efficacies of amoxicillin and cefuroxime in the
treatment of children with Otitis media. According to a recent US data, cefuroxime has 80%
efficacy against S pneumonia as compared to 90% efficacy of amoxicillin (6). In vitro, the
efficacy of cefuroxime is 98% against H influenzae as compared to amoxicillin having 58%
efficacy (7). H influenzae also develop resistance against antibiotic, amoxicillin and
hypersensitivity reactions develop among children with Otitis media.
The investigation of efficacies of these two antibiotics is important to provide timely
treatment to children with Otitis media with decrease in symptoms and related to the discipline
and line of research, medicine. Moreover, this investigation would help in reducing physical
suffering, emotional distress and behavioural problems that greatly affect the quality of life of