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Otitis media
Michael E Pichichero1, Janet R Casey
1Elmwood Pediatric Group, University of Rochester Medical Center, Rochester, NY 14642, USA. michael_pichichero@urmc.rochester.edu
Abstract:
Bacterial pathogens are isolated from middle ear fluid in up to 90% of children with acute otitis media (OM). Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis predominate. Acute OM can be classified as uncomplicated, persistent, recurrent or chronic. Patient age, symptom severity, prior treatment history and exposure through day-care attendance in children influences pathogen distribution, antimicrobial susceptibility and anticipated clinical and microbiological responses to empirical and pathogen-directed therapies. The natural history of acute OM without intervention is favourable. However, meta-analysis of clinical trials shows an improvement in symptom and middle ear effusion resolution with antimicrobials. Aminopenicillins, cephalosporins and macrolides are often selected as therapy for acute OM. The various agents have differing activity against acute OM pathogens, particularly organisms with resistance mechanisms and they differ in dosing schedule, side effects and compliance enhancing factors. Consideration should be given to pharmacokinetic and pharmacodynamic principles in antibiotic selection. Selection criteria include antibiotic activity against drug-resistant S. pneumoniae and efficacy against beta-lactamase-producing Gram-negative organisms. The necessary duration of treatment for acute OM varies according to multiple factors, including local preferences, but there is growing, compelling data to support short-course therapy. Tympanocentesis has been endorsed in various guidelines as a diagnostic and therapeutic procedure. Best-practice for management of acute OM continues to advocate antibiotic therapy with careful, accurate diagnosis and consideration of the major pathogens and their mechanisms of resistance.
Insights
Acute otitis media (OM) in children is often caused by bacteria like Streptococcus pneumoniae. Antibiotic therapy, particularly short-course treatments, improves symptom resolution, but careful diagnosis considering pathogen resistance is crucial.
Area of Science:
- Otolaryngology
- Pediatrics
- Infectious Diseases
Background:
- Acute otitis media (OM) commonly involves bacterial pathogens, predominantly Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- OM classification includes uncomplicated, persistent, recurrent, and chronic forms, influenced by patient factors and day-care exposure.
Purpose of the Study:
- To review the management of acute otitis media, focusing on pathogen distribution, antimicrobial susceptibility, and therapeutic responses.
- To highlight the role of antibiotic selection based on pharmacokinetic/pharmacodynamic principles and resistance mechanisms.
Main Methods:
- Review of clinical trials and meta-analyses on acute otitis media treatment.
- Analysis of factors influencing pathogen distribution and antimicrobial susceptibility in children.
Main Results:
- While OM can resolve naturally, antimicrobials improve symptom and effusion resolution.
- Antibiotic choice (aminopenicillins, cephalosporins, macrolides) impacts efficacy against resistant pathogens.
- Short-course therapy is increasingly supported by compelling data.
Conclusions:
- Best-practice management involves accurate diagnosis, consideration of major pathogens and resistance, and antibiotic therapy.
- Antibiotic selection should prioritize activity against drug-resistant S. pneumoniae and beta-lactamase-producing Gram-negatives.
- Tympanocentesis is a recognized diagnostic and therapeutic procedure.