Cephalosporins in overcoming beta-lactamase-producing bacteria and preservation of the interfering bacteria in the treatment of otitis, sinusitis and tonsillitis.

The treatment of upper respiratory tract infections (URTIs) is complicated by the resurgence of beta-lactamase-producing bacteria (BLPB) and the absence of interfering bacteria. BLPB can have a direct pathogenic impact in causing the infection as well as an indirect impact through their ability to produce the enzyme beta-lactamase. BLPB may not only survive penicillin therapy but can also protect other penicillin-susceptible bacteria from penicillin. In this review, the clinical in vitro and in vivo evidence supporting the role of these organisms in the increased failure rate of penicillin in eradication of otitis, sinusitis and pharyngo-tonsillitis is outlined and the implication of that increased rate on the management of infections is discussed. Bacteria with interference capability of potential respiratory pathogens can prevent colonization and subsequent invasion by these organisms. These include alpha-hemolytic streptococci, nonhemolytic streptococci and Prevotella and Peptostreptococcus spp. Treatment with antimicrobials can affect the balance between the interfering organisms and potential pathogens. The role of bacterial interference in URTIs and its effect on their treatment is discussed. The use of some of the cephalosporins that are able to overcome the effect of BLPB and preserve the beneficial interfering bacteria can overcome and modulate these phenomena and achieve better cure of URTIs.