Treatment of early recurrences of acute purulent otitis media; value of myringotomy.

The present investigation was carried out in order to study the efficacy of oral antibiotics (A) versus oral antibiotics plus acute myringotomy (B) in the treatment of early recurrences of acute purulent otitis media. Seventy-nine children with early recurrences (arisen within 4 weeks of a primary episode) were randomly allocated to one of the two treatment groups (A or B). Eleven of 41 (26.8%) children in group A, and 12/38 (31.6%) in group B had healed at 4 weeks (p greater than 0.1). Seventeen children of both groups had secretory otitis media at 4 weeks and new relapses had occurred in 13 children in group A and 9 in group B. No difference between the groups was noted regarding the number of otitis episodes during the next 5 months. Thus, acute myringotomy could not be proven to affect the clinical course of an early recurrence of acute purulent otitis media as compared with that after treatment with oral antibiotics alone.

Collection and transport of specimens for anaerobic culture.

By comparative studies of sampling methods it was shown that specimens should be obtained preferably by aspiration in order to avoid contamination by anaerobic flora. Anaerobic transport systems are recommended, though some anaerobic strains tolerate exposure to air surprisingly well. A gassed-out tube or vial is the method of choice for transporting fluid specimens for anaerobic culture.

Pharmacological and clinical study of bacampicillin in acute peritonsillitis--a comparison with ampicillin.

The pharmacological and clinical properties of bacampicillin in three dosage groups were studied in 66 hospitalized patients with unilateral acute peritonsillitis in a comparison with ampicillin. Bacampicillin is a new semisynthetic aminopenicillin which is rapidly converted to ampicillin but is better absorbed. Both drugs were given orally. The mean individual peak serum levels achieved with 200, 400, and 800 mg of bacampicillin in the first morning dose were 4.9, 6.8, and 11.9 mg/liter, respectively, with an almost linear dose response. The peak level of 800 mg of bacampicillin was significantly higher than the 6.8 mg/liter noted after a nearly equimolar dose of 500 mg of ampicillin. A linear relationship was also seen between dose and area under the serum concentration-time curve. Preliminary antibiotic concentration studies in five patients indicated therapeutic levels in peritonsillar pus. Beta-streptococci alone or in combination with anaerobes were isolated from about half of the abscesses, whereas anaerobes were isolated from the other half. Treatment was supplemented by surgical procedures in the majority of cases. The clinical effect was good in all treatment groups, with only one relapse. All beta-streptococci were eliminated during therapy. The total number of gastrointestinal side effects was significantly lower in patients treated with bacampicillin, although the difference in frequency of diarrhea alone was not significant.

Microbiological aspects on peritonsillar abscesses.

In 37 patients with unilateral quinsy put was collected with a syringe technique and bacteriologically examined. Beta-hemolytic streptococci were isolated from 17 abscesses; in 8 of these, however, together with other bacteria, mainly anaerobes. Anaerobic bacteria, often more than one species, were found in 28 abscesses. Streptococcal serology including AST-O, Streptozyme and separate ADNAse test showed high titres or titre rises in 22 out of 30 examined cases. There was one case with beta-hemolytic streptococci in the abscess but negative serology. In the remaining cases a possible primary etiological role of anaerobes is suggested. The effect of combined surgical drainage and treatment with antibiotics (ampicillin or penicillin V) was good.

Influence of the collection and transport of specimens on the recovery of bacteria from peritonsillar abscesses.

In 30 patients with peritonsillar abscesses, pus was obtained by aspiration and by taking a swab after incision; bacterial recovery was compared. Although processed in the laboratory within 2 h, swab speciments gave results comparable to syringe specimens in only 9 of 13 patients with beta-hemolytic streptococci and 7 of 25 patients with anaerobic bacteria. Both kinds of microorganisms were lost in some cases but appeared as additional flora in others. The poor results from the swab technique was ascribed to overgrowth of respiratory flora contaminating the sample after incision. In aspirated pus kept in the syringe, or transferred to anaerobic transporters, the microbial flora was unchanged for 24 to 48 h. Some anaerobes also survived on agar slants for 24 h, but specially designed anaerobic transporters are recommended.