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Published on: February 23, 2014
[Acute otitis media in the era of pneumococcal vaccination]
Fernando Baquero-Artigao1, Fernando del Castillo
1Unidad de Enfermedades Infecciosas Pediátricas, Hospital Universitario Infantil La Paz, Madrid, España. fbaquero@terra.es
Insights
Acute otitis media (AOM) is common in children, often leading to antibiotic overuse and resistance. Observation periods and vaccines show limited impact, necessitating revised treatment guidelines for AOM.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Acute otitis media (AOM) is a leading childhood illness and a primary driver of antibiotic prescriptions.
- Indiscriminate antibiotic use for AOM contributes to antimicrobial resistance.
- Clinical guidelines aim to promote judicious antibiotic use due to AOM's high spontaneous resolution rates and minimal antibiotic benefits.
Purpose of the Study:
- To review the impact of vaccines and current treatment strategies on antibiotic resistance in AOM.
- To evaluate the effectiveness of observation policies and vaccines against common AOM pathogens.
- To inform future clinical guidelines for AOM management.
Main Methods:
- Literature review of studies on AOM epidemiology, treatment, and vaccine efficacy.
- Analysis of antibiotic resistance trends in relation to vaccination programs.
- Evaluation of the impact of Streptococcus pneumoniae and Haemophilus influenzae vaccines on AOM.
Main Results:
- The 7-valent pneumococcal conjugate vaccine shows moderate efficacy against vaccine serotypes but limited overall impact due to serotype replacement.
- While pneumococcal resistance to penicillin has decreased in vaccinated children, resistance to other antibiotics is increasing in non-vaccine serotypes.
- Haemophilus influenzae type b vaccines have minimal effect on AOM as most strains are nontypable.
Conclusions:
- A policy of observation for 48-72 hours is often justified for AOM due to high spontaneous resolution rates.
- Vaccine efficacy against AOM is limited by serotype replacement and the prevalence of nontypable strains.
- The rise of non-vaccine serotypes and nontypable H. influenzae may necessitate revising the first-line treatment recommendations for AOM, potentially moving away from high-dose amoxicillin.
Abstract:
Acute otitis media (AOM) is one of the most common childhood diseases and the main reason for prescribing antibiotics in developed countries. Indiscriminate treatment of children with an inconclusive diagnosis has favored the development of resistance, and this has led to the creation of clinical guidelines to promote judicious antibiotic use. AOM has shown high rates of spontaneous resolution and minimal benefits from antibiotics; hence a policy of observation for 48-72 hours before initiating treatment is justified in many children. In recent years, attention has been focused on developing effective vaccines against the most common causative pathogens, Streptococcus pneumoniae and Haemophilus influenzae. The H. influenzae type b conjugate vaccine has little impact on AOM since most strains are nontypable. The 7-valent pneumococcal conjugate vaccine has an efficacy of 55% in AOM caused by vaccine serotypes, but replacement with nonvaccine serotypes and nontypable H. influenzae reduce the overall efficacy of the vaccine to 6-8%. An overall decrease of pneumococcal resistance to penicillin has been seen in vaccinated children, but there is a trend to an increase in antibiotic resistance in non-vaccine serotypes. High-dose amoxicillin is the treatment of choice for AOM, but the increase of H. influenzae in pneumococcal-vaccinated children may require reconsideration of this recommendation in forthcoming guidelines.
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