Real World Evidence (RWE, Real World Data), of the Effectiveness of Amoxicillin-Clavulanate in the Treatment of Children with Upper Respiratory Tract Infections (Tonsillitis, Otitis, Sinusitis)
Real-world evidence (RWE) is clinical evidence on a medical product’s safety and efficacy that is generated using real-world data (RWD) resulting from routine healthcare delivery. This study evaluates the clinical efficacy of amoxicillin + clavulanic acid in children with pharyngitis, acute otitis, or acute rhinosinusitis with suspected bacterial origin under normal office and home conditions. Methods: This was a real-life, prospective, observational, pharmacovigilance study. It included children of both sexes between 2 and 12 years old, with a diagnosis of Rhinopharyngitis (tonsillitis), Acute Otitis Media and Rhinosinusitis. The main effectiveness variable evaluated was reduction and time to resolution of symptoms. All patients received Amoxicillin/Clavulanic Acid suspension 600 mg/42.9 mg/5 mL at a dose of 90 mg/Kg/day in two doses, every 12 hours for 7 days. The evaluations were carried out at the beginning, at 72 hours (3rd day) and at 7 days. All patients underwent culture and antibiogram. Results: The majority of cultures were negative for pathogenic germs, suspecting unidentifiable germs, or viral etiology despite the rigorous selection of subjects following validated scores. The most frequently isolated germ was Staphylococcus aureus; growth of gram-negative bacteria was reported in 33.33% of the cultures. There was a significant improvement in symptoms in children with tonsillitis and rhinosinusitis from the first 72 hours of treatment, persisting until the 7 days. In the otitis media group, returning to normal by the tenth day. During the conduction of this investigation, no adverse effects associated with the prescribed therapy were reported.
References
[1]
U.S. Food and Drugs Administration (2018) Framework for FDA’s Real-World Evidence Program.
[2]
Bhatt, A. (2019) Conducting Real-World Evidence Studies in India. Perspectives in Clinical Research, 10, 51-56. https://doi.org/10.4103/picr.picr_8_19
[3]
Cots, J.M., Alós, J., Bárcena, M., Boleda, X., Cañada, J.L., Gómez, N., et al. (2015) Recommendations for Management of Acute Pharyngitis in Adults. Acta Otorrinolaringologica (English Edition), 66, 159-170. https://doi.org/10.1016/j.otoeng.2015.05.003
[4]
Pediamecum AEP (2021) Amoxicillin Technical Data Sheet. https://www.aeped.es/comite-medicamentos/pediamecum/amoxicilina
[5]
Pediamecum AEP (2021) Amoxicillin/Clavulanic Acid Technical Data Sheet. https://www.aeped.es/comite-medicamentos/pediamecum/amoxicilina-clavulanico
[6]
Denise, I.T., Kilstein Jorge, G. and Marta, Q. (2016) Utilidad de los criterios de predicción clínica y del test rápido antigénico para el manejo de la faringitis aguda en un servicio de urgencias. RevistaClínica de Medicina de Familia, 9, 23-30. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1699-695X2016000100005&lng=es
[7]
Sociedad Venezolana de Otorrinolaringología (2018) VI Consenso Venezolano en Infecciones otorrinolaringológicas.
[8]
Byrjalsen, A., Ovesen, T. and Kjaergaard, T. (2014) Staphylococcus Aureus Is a Major Pathogen in Severe Acute Bacterial Rhinosinusitis. Rhinology Journal, 52, 48-52. https://doi.org/10.4193/rhino13.004
[9]
Lieberthal, A.S., Carroll, A.E., Chonmaitree, T., Ganiats, T.G., Hoberman, A., Jackson, M.A., et al. (2013) The Diagnosis and Management of Acute Otitis Media. Pediatrics, 131, e964-e999. https://doi.org/10.1542/peds.2012-3488
[10]
Shaikh, N., Hoberman, A., Paradise, J.L., Wald, E.R., Switze, G.E., Kurs-Lasky, M., et al. (2009) Development and Preliminary Evaluation of a Parent-Reported Outcome Instrument for Clinical Trials in Acute Otitis Media. Pediatric Infectious Disease Journal, 28, 5-8. https://doi.org/10.1097/inf.0b013e318185a387
[11]
Shaikh, N., Hoberman, A., Paradise, J.L., Rockette, H.E., Kurs-Lasky, M., Colborn, D.K., et al. (2009) Responsiveness and Construct Validity of a Symptom Scale for Acute Otitis Media. Pediatric Infectious Disease Journal, 28, 9-12. https://doi.org/10.1097/inf.0b013e318185a3a0
[12]
Bolaños-Díaz, R. and Calderón-Cahua, M. (2014) Cefprozil versus Amoxicillin/clavulanate for the Treatment of Acute Otitis Media in Children: Meta-Analysis of Efficacy and Safety. Pharmacology & Pharmacy, 5, 386-394. https://doi.org/10.4236/pp.2014.54046
[13]
Knobbe, R.B., Diallo, A., Fall, A., Gueye, A.D., Dieng, A., van Immerzeel, T.D., et al. (2019) Pathogens Causing Respiratory Tract Infections in Children Less than 5 Years of Age in Senegal. Microbiology Insights, 12, 1-8. https://doi.org/10.1177/1178636119890885
[14]
Diagne, G., Kane, A., Mbaye, A., Coundoul, A.M., Sow, S., Bop, K., et al. (2021) Bacteriological Profile of Acute Respiratory Infections in Children: About a Prospective Study at the Albert Royer Hospital in Dakar. Open Journal of Pediatrics, 11, 71-77. https://doi.org/10.4236/ojped.2021.111007
[15]
Bert, F., Previti, C., Calabrese, F., Scaioli, G. and Siliquini, R. (2022) Antibiotics Self Medication among Children: A Systematic Review. Antibiotics, 11, Article 1583. https://doi.org/10.3390/antibiotics11111583
[16]
Haidara, A.W., Sidibé, Y., Samaké, D., Coulibaly, A., Touré, M.K., Coulibaly, B.B., et al. (2019) Tonsillitis and Their Complications: Epidemiological, Clinical and Therapeutic Profiles. International Journal of Otolaryngology and Head & Neck Surgery, 8, 98-105. https://doi.org/10.4236/ijohns.2019.83011
[17]
Yang, L., Dharmaratne, P., Zhu, C., Sapugahawatte, D.N., Rahman, N., Barua, N., et al. (2024) Global Epidemiology of Asymptomatic Colonisation of Methicillin-Resistant Staphylococcus aureusin the Upper Respiratory Tract of Young Children: A Systematic Review and Meta-Analysis. Archives of Disease in Childhood, 109, 267-274. https://doi.org/10.1136/archdischild-2023-326124
[18]
Morgene, M.F., Botelho-Nevers, E., Grattard, F., Pillet, S., Berthelot, P., Pozzetto, B., et al. (2018) Staphylococcus aureus Colonization and Non-Influenza Respiratory Viruses: Interactions and Synergism Mechanisms. Virulence, 9, 1354-1363. https://doi.org/10.1080/21505594.2018.1504561