Changes in treatment strategies for acute otitis media after full implementation of the pneumococcal seven valent conjugate vaccine.
BACKGROUND
Administration of the pneumococcal seven valent conjugate vaccine (PCV-7) results in significant reductions in the incidence of invasive pneumococcal disease and nasopharyngeal colonization rates; however, the reduction in the overall incidence of acute otitis media (AOM) is minimal. Despite an ongoing shortage of PCV-7 in the United States, during which children are receiving fewer doses at longer intervals than the recommended dosing schedule, the incidence of invasive pneumococcal disease in young children has continued to decrease.


OBJECTIVE
The purpose of this article is to review why the reported effect of PCV-7 on AOM infection rates does not match the reduction in invasive pneumococcal disease or the reduction in nasopharyngeal carriage of Streptococcus pneumoniae.


METHODS
The potential effect of a fully implemented PCV-7 schedule on AOM infections is calculated based on serotype-specific AOM reduction rates observed in clinical studies. Clinical success rates of various antimicrobials used in the treatment of AOM in children fully immunized with PCV-7 also are calculated based on projected PCV-7-induced changes in pathogen profiles and documented antimicrobial resistance rates. Questions regarding potential serotype substitution in children with AOM but not invasive pneumococcal disease, the increased incidence of infection with Haemophilus influenzae in children immunized with PCV-7 and the possibility of herd immunity also will be addressed.


RESULTS
Although the majority of penicillin-nonsusceptible S. pneumoniae are included in PCV-7, AOM caused by these strains will not completely disappear, especially in children 24 months of age and younger.


CONCLUSIONS
Consequently, clinicians must continue to consider penicillin-nonsusceptible pneumococci when prescribing antimicrobials for AOM.
Harrison
Christopher J
CJ
Department of Pediatrics, University of Louisville, Louisville, KY, USA.
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D006801:Humans; D007223:Infant; D009305:Nasopharynx / Q000382:microbiology; D010033:Otitis Media / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012307:Risk Factors; D018074:Vaccines, Conjugate / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate