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Failure of antibiotic therapy in acute otitis media
Emmanuel Babin1, Vincent Lemarchand, Sylvain Moreau
1Department of Otolaryngology - Head and Neck Surgery, Caen University Hospital, F-14033 Caen Cedex, France. babin-e@chu-caen.fr
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.
Insights
Antibiotic treatment failure in acute otitis media (AOM) in children is often due to resistant bacteria like Haemophilus influenzae and less susceptible Streptococcus pneumoniae. Viral infections or multiple bacteria may also contribute to treatment failure.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Otolaryngology
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Antibiotic therapy is the primary treatment for AOM.
- Treatment failures necessitate understanding underlying causes.
Purpose of the Study:
- To investigate the microbiological reasons for antibiotic treatment failure in pediatric AOM.
- To identify bacterial pathogens and their resistance patterns in children with persistent AOM.
Main Methods:
- Retrospective analysis of middle-ear fluid samples from 31 children with AOM unresponsive to antibiotics.
- Microbiological analysis including bacterial cultures, beta-lactamase testing, and penicillin susceptibility testing for Streptococcus pneumoniae.
- Identification of bacterial species and determination of minimal inhibitory concentrations (MICs).
Main Results:
- Bacterial pathogens were identified in 25 out of 39 middle-ear fluid samples.
- Haemophilus influenzae was the most frequent isolate (11 samples).
- Streptococcus pneumoniae was found in 7 samples, with 4 isolates showing reduced penicillin susceptibility.
Conclusions:
- Increased resistance of Haemophilus influenzae and reduced susceptibility of Streptococcus pneumoniae to penicillin are key factors in AOM treatment failure.
- The presence of viruses or multiple bacterial pathogens in the middle ear may also contribute to treatment failure.
- Understanding these factors is crucial for optimizing AOM management in children.