Otitis media in children

Acute otitis media is one of the commonest diseases of childhood. Most cases are due to Streptococcus pneumoniae and can be treated safely with penicillin. However, Hemophilus influenzae is also common, particularly under the age of five. In many areas it is increasingly resistant to ampicillin and should be treated with a trimethoprim-sulfamethoxazole preparation (Bactrim, Septra). The new agent, cefaclor (Ceclor) may prove to be a valid alternative. In the first few months of life, special problems include difficulty in recognition, a greater frequency of atypical organisms including Escherichia coli, and associated serious systemic illnesses. Recurrent suppurative otitis media (three or more episodes of acute otitis media in a six month period) is an indication for prophylactic antimicrobial therapy.The most common complication of acute otitis media is persistence of effusion. Risk factors include resistance of the organism(s) to the initial antimicrobial agent and the presence of coexisting allergy. Tympanostomy tubes and adenoidectomy should be considered in selected cases. A key to successful treatment is careful follow up after each episode to assure the restoration of normal hearing.