Effects of amoxicillin and cefdinir on nasopharyngeal bacterial flora

Objective: To compare the effects of cefdinir (14 mg/kg per day) and amoxicillin (90 mg/kg per day) antimicrobial therapy on the nasopharyngeal flora of children with acute otitis media. Design: Nasopharyngeal cultures for aerobic and facultative bacteria were obtained before therapy and 2 to 4 days after completion of therapy. Setting: Outpatient clinic. Patients: Fifty children, aged 7 months to 5 years 4 months. Main Outcome Measures: After completion of therapy, 22 (88%) of the 25 patients treated with cefdinir and 16 (64%) of the 25 patients treated with amoxicillin were considered clinically cured (P < .05). A significant reduction in the number of all isolates occurred following therapy in those treated with cefdinir (36 vs 71, P < .01) or with amoxicillin (56 vs; 73, P < .05). However, the total number of isolates recovered after therapy was significantly lower in those treated with cefdinir (36) compared with those treated with amoxicillin (56) (P < .01). Results: The recovery of potential pathogenic organisms (eg, Streptococcus pneumoniae, Staphylococcus aureus, P-hemolytic streptococci, Haemophilus species, and Moraxella catarrhalis), as well as penicillin-resistant bacteria, was lower following completion of therapy in the cefdinir group (6 pathogens, including 5 that were penicillin resistant), compared with the amoxicillin group (27 pathogens, including 16 that were penicillin resistant) (P < .01). Conclusion: This study illustrates the greater ability of cefdinir compared with amoxicillin to reduce the number of potential nasopharyngeal pathogens as well as penicillin-resistant bacteria in children with acute otitis; media.