From the Guidelines
Roxithromycin is not the preferred treatment for otitis media due to its limited spectrum of activity against the most common bacterial pathogens, including S. pneumoniae, H. influenzae, and M. catarrhalis 1. When considering treatment for otitis media, it is essential to choose an antimicrobial agent that is active against the most common bacterial pathogens. The preferred antimicrobial agent for the patient with otitis media must be active against S. pneumoniae, H. influenzae, and M. catarrhalis.
- Amoxicillin or an equivalent has been the standard regimen for otitis media since it is effective against most strains of the three major pathogens and is well tolerated, producing limited adverse effects 1.
- However, since at present 20%-30% of H. influenzae strains and 50%-70% of M. catarrhalis strains in the United States produce β-lactamase, a β-lactamase-stable agent (such as amoxicillin plus a β-lactamase inhibitor, a second- or third-generation cephalosporin) or a combination such as trimethoprim-sulfamethoxazole or erythromycin/sulfisoxazole may also be used 1.
- Roxithromycin, an erythromycin derivative, may be used as an alternative treatment for otitis media, particularly in patients with penicillin allergy or resistance, but its effectiveness is limited compared to other antimicrobial agents 1. It is crucial to note that approximately one-third of children with otitis media caused by a bacterial pathogen improve without treatment with antibacterial drugs, and clinical resolution may occur because the contents of the middle ear are spontaneously discharged, either through the eustachian tube or by means of a spontaneous perforation of the TM 1.
- Before starting any antibiotic treatment, it's essential to have the ear infection properly diagnosed by a healthcare provider, as not all ear infections require antibiotics.
- The treatment duration for otitis media is typically 5-7 days, and it's crucial to complete the full course of antibiotics even if symptoms improve before finishing.
From the Research
Efficacy of Roxithromycin for Treating Otitis Media
- Roxithromycin is a derivative of the macrolide antibacterial erythromycin, with in vitro antibacterial activity resembling that of the parent compound 2.
- It has activity against some Staphylococcus spp., many Streptococcus spp., Moraxella (Branhamella) catarrhalis, Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydia trachomatis, as well as many less common organisms 2.
- Roxithromycin has proven clinical efficacy in upper and lower respiratory infections, skin and soft tissue infections, urogenital infections, and orodental infections, and appears to be as effective as more established treatments including erythromycin, amoxicillin/clavulanic acid, and cefaclor 2.
Comparison with Other Antibiotics
- A study comparing azithromycin, amoxicillin/clavulanic acid, and cefaclor in the treatment of acute ENT infections found that azithromycin had a higher clinical effectiveness and faster improvement in symptoms compared to amoxicillin/clavulanic acid and cefaclor 3.
- Another study comparing clarithromycin and amoxicillin suspensions in the treatment of pediatric patients with acute otitis media found that clarithromycin had a similar clinical success rate to amoxicillin 4.
- A study comparing amoxicillin/clavulanate and azithromycin in acute otitis media found that amoxicillin/clavulanate was more likely to eradicate bacterial pathogens, including Haemophilus influenzae, from middle ear fluid than azithromycin 5.
Roxithromycin's Potential for Treating Otitis Media
- While there is no direct evidence on the effectiveness of roxithromycin for treating otitis media, its similarity in structure and activity to other macrolide antibiotics, such as azithromycin and clarithromycin, suggests that it may be effective in treating this condition 2.
- However, more research is needed to confirm the efficacy of roxithromycin in treating otitis media, as the current evidence is indirect and based on studies of other macrolide antibiotics 3, 2, 4, 5.