Failure of antibiotic therapy in acute otitis media

Abstract

The aim of this retrospective study was to determine the possible causes of failure of antibiotic therapy in children with acute otitis media (AOM). Thirty-nine samples of middle-ear fluid were obtained by myringotomy from 31 children suffering from AOM, unrelieved by antibiotic therapy administered for over 48 hours. The samples were analysed by the usual microbiological techniques, including cultures, tests for beta-lactamase producing strains and the determination of the minimal inhibitory concentration of penicillin for Streptococcus pneumoniae. In 14 samples, no bacterial strains were detected in the cultures of middle-ear fluid; and in two samples the cultures revealed two strains of bacteria. The bacteria most frequently identified were Haemophilus influenzae, found in 11 samples, and Streptococcus pneumoniae, found in seven samples, of which four produced strains with reduced susceptibility to penicillin. The failure of antibiotic therapy in AOM appears to be related to the increased resistance of Haemophilus influenzae and to the reduced susceptibility of Streptococcus pneumoniae to penicillin. Other factors contributing to the failure of antibiotic therapy in AOM may be the viruses or the bacteria that produce multiple pathogens in the middle ear.

Bacteriology of medically refractory acute otitis media in children: a 9-year retrospective study

“…Although there are some differences in bacteriology of AOM comparing Taiwan and Western countries, gram-positive bacteria are still the most frequently recovered pathogens. Our treatment protocols for AOM in children are similar to those reported in other studies [1][2][3][4][5][6][7][8][9]. Amoxicillin remains the first choice in such cases.…”

“…Organisms resistant to the antibiotics prescribed, persistence of inflammation despite elimination of the bacteria, concurrent viral infection, impaired host defenses, and inadequate antibiotic penetration into the positively pressurized middle-ear space are but a few of the potential reasons for clinical failure [1][2][3][6][7][8][9][10]. In this study, bacteria were recovered from samples from 12 of the 25 ears, yielding a positive culture rate of 48%.…”

Zygomatic Abscess with Temporomandibular Joint Effusion Complicating Acute Otitis Media

“…Anaerobic otitis media or mastoiditis tends to follow a subacute and subclinical course in comparison with the course of aerobic illness (22). This is shown by an afebrile course, a lack of periauricular pain or tenderness, a noninflamed tympanic membrane, and a near-normal leukocyte count (23). In our case, the clinical course was rather serious, but anaerobic microorganism might be the reason for the negative culture.…”

Zygomatic abscess with temporal myositis — a rare extracranial complication of acute otitis media

“…The problem of increased bacterial resistance in acute mastoiditis was also observed by other authors [8,11,18,20]. Bacteria cultured from the middle ear and mastoid effusions are more resistant to regularly applied antibiotics than the bacteria found in uncomplicated AOM [11,15]. Streptococcus pneumoniae is the most frequently cultured bacteria in cases of both AOM and its complications [11].…”

“…Acute mastoiditis and its complications should be treated initially with intravenous antibiotics (semisynthetic penicillin and chloramphenicol) and surgically, when the patient fails to respond to antibiotics within 72 h [15,16]. Each case of mastoiditis with purulent intratemporal or extracranial complication should be treated surgically, by myringotomy or myringostomy, mastoidectomy with pus drainage and granulation tissue removal.…”