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Recurrent and persistent otitis media
1Elmwood Pediatric Group, University of Rochester, NY 14642, USA. mepo@uhura.cc.rochester.edu
Insights
Recurrent acute otitis media affects many children, often caused by resistant bacteria. Optimal management requires accurate diagnosis and appropriate antibiotic selection to combat treatment failure and relapses.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Recurrent acute otitis media affects 20-30% of young children.
- Persistent otitis media involves treatment failure or relapse within one month of antibiotic completion.
- Accurate diagnosis is crucial to differentiate from otitis media with effusion and prevent overtreatment.
Purpose of the Study:
- To outline challenges in managing recurrent and persistent acute otitis media.
- To identify key pathogens and risk factors.
- To recommend optimal antibiotic strategies.
Main Methods:
- Review of clinical challenges and risk factors for recurrent and persistent otitis media.
- Identification of predominant pathogens, including antibiotic-resistant Streptococcus pneumoniae and Haemophilus influenzae.
- Evaluation of recommended antibiotic treatments based on CDC guidelines.
Main Results:
- Predominant pathogens include antibiotic-resistant Streptococcus pneumoniae and beta-lactamase-producing Haemophilus influenzae.
- Recommended treatments include high-dose amoxicillin/clavulanate, cefuroxime axetil, and ceftriaxone.
- Suboptimal antibiotics or those with insufficient data were noted.
Conclusions:
- Optimal management of recurrent and persistent acute otitis media is a clinical challenge.
- Accurate diagnosis is the critical first step.
- Antibiotic selection must consider major pathogens and antibiotic resistance.
Abstract:
Recurrent acute otitis media occurs during the first several years of life in approximately 20 to 30% of the pediatric population. A clinical challenge closely related to recurrent otitis media is persistent otitis media, manifested by persistence during antimicrobial therapy of symptoms and signs of middle ear infection (treatment failure) and/or relapse of acute otitis media within 1 month of completion of antibiotic therapy. Recurrent and persistent otitis media infections are early childhood problems with identifiable risk factors. Differentiation of these infections from otitis media with effusion is important in avoiding misdiagnosis and overtreatment with antibiotics. The predominant pathogens of recurrent and persistent acute otitis media are antibiotic-resistant Streptococcus pneumoniae and beta-lactamase-producing Haemophilus influenzae. A working group convened by the Centers for Disease Control recommended three antibiotics for the treatment of recurrent and persistent acute otitis media: (1) amoxicillin/clavulanate in combination with amoxicillin (high dose amoxicillin regimen, 80 to 90 mg/kg/day); (2) cefuroxime axetil (standard dose, 30 mg/kg/day); and (3) ceftriaxone (possibly requiring up to three injections to optimize clinical success). Other antibiotics were considered suboptimal or had accumulated insufficient data upon which to base a judgment. Conclusions. Optimal management of recurrent and persistent acute otitis media is a clinical challenge. Accurate diagnosis of acute otitis media is the first step in optimal management. Selection of appropriate antibiotic therapy should take into account the major pathogens (S. pneumoniae, H. influenzae and Moraxella catarrhalis) and the occurrence of antibiotic resistance.