Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media Recommendations of a Clinical Advisory Committee

Abstract

Streptococcus pneumoniae is the predominant bacterial pathogen associated with acute otitis media (AOM), causing an estimated 7 million cases annually in the United States. Bacterial resistance should be considered when selecting an antimicrobial agent for otitis media. Significant increases in drug-resistant S pneumoniae are documented worldwide, and less than 50% oî S pneumoniae strains are fully susceptible to penicillin in some regions of the United States. Although amoxicillin is recommended for uncomplicated AOM, treatment guidelines should be flexible and adaptable, taking into consideration local and regional susceptibility patterns, the age of the patient, the frequency of prior infections, and the response to prior therapy. Resistant organisms are more prevalent in children younger than 2 years of age and in those who have recurrent or persistent AOM. Overdiagnosing AOM, selecting inappropriate empiric therapy, or both, leads to overuse and misuse of antibiotics and causes increased drug resistance. This article reviews persistent and recurrent AOM and discusses the pitfalls of diagnosis and the practical limitations of current treatment recommendations. KEY WORDS-cephalosporin, drug-resistant Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, otitis media, penicillin.

Factors associated with acute otitis media in children due to penicillin intermediately resistant Streptococcus pneumoniae

“…The influence of antibiotic resistance to the clinical course of AOM due to S. pneumoniae was not clear. Risk factors for persistent and recurrent AOM have been discussed in many studies and other factors such as an episode of AOM during the first 6 months, young age (<2 years of age), passive smoking, siblings, breast feeding, day-care attendance have been mentioned since then [6]. In addition, 24-h nursing might have a strong influence on the clinical course of cases.…”

Otitis media

“…Two selection criteria are recommended: the antibiotic should be effective against most drugresistant S. pneumoniae and it should be effective against βlactamase producing H. influenzae and M. catarrhalis. On the basis of these criteria, a treatment algorithm has been developed (Figure 2) [139]. In forming these recommendations, trials in which tympanocentesis was performed were most prominently considered to avoid the problem of basing recommendations on patients who have been inaccurately diagnosed.…”

Antibióticos en las infecciones respiratorias

“…La otitis media (OM) es una de las infecciones más frecuentes, sobre todo en la infancia. Se clasifica según síntomas y presencia de derrame [4][5][6] .…”

“…años, el 91% antes de los 5 años, y el 17% ha tenido tres o más episodios en el primer año. El pico de edad de máxima incidencia de OMA se produce entre los 6 y los 15 meses [6][7][8][9][10] .…”