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Relationship with original pathogen in recurrence of acute otitis media after completion of amoxicillin/clavulanate:

Ravinder Kaur1, Janet R Casey, Michael E Pichichero

  • 1From the *Rochester General Hospital Research Institute; and †Legacy Pediatrics, Rochester, NY.

The Pediatric Infectious Disease Journal
|June 6, 2013
PubMed
Abstract

Insights

Recurrent acute otitis media (rAOM) after amoxicillin/clavulanate treatment is often caused by Nontypeable Haemophilus influenzae (NTHi) relapses. New pathogens increasingly cause rAOM in the weeks following treatment.

Area of Science:

  • Pediatric Infectious Diseases
  • Microbiology
  • Otolaryngology

Background:

  • Recurrent acute otitis media (rAOM) poses a significant challenge in pediatric care.
  • Understanding the etiology of rAOM post-antibiotic treatment is crucial for effective management.

Purpose of the Study:

  • To differentiate between bacterial relapse and new infections in children experiencing rAOM within 30 days of amoxicillin/clavulanate therapy.
  • To identify the primary otopathogens responsible for rAOM following treatment.

Main Methods:

  • Prospective longitudinal study of children aged 6-36 months with rAOM after amoxicillin/clavulanate.
  • Multilocus sequence typing (MLST) used to genotype bacterial isolates from middle ear fluid.
  • Comparison of otopathogens from initial AOM episodes and subsequent rAOM.

Main Results:

  • Nontypeable Haemophilus influenzae (NTHi) was the predominant otopathogen in both initial AOM (47%) and rAOM (42%).
  • NTHi was responsible for the majority of true bacteriologic relapses (77%).
  • The likelihood of new pathogens causing rAOM increased significantly in the weeks following antibiotic treatment.

Conclusions:

  • Nontypeable Haemophilus influenzae (NTHi) is the primary cause of true bacteriologic relapses in rAOM post-amoxicillin/clavulanate treatment.
  • The incidence of new pathogens causing rAOM increases progressively in the weeks after treatment cessation.
  • Neither relapses nor new infections were more frequently associated with beta-lactamase-producing NTHi or penicillin-nonsusceptible Streptococcus pneumoniae.

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