Acute otitis media caused by drug-resistant bacteria: correlation with antibiotic treatment.
OBJECTIVE
Although acute otitis media (AOM) is the commonest infectious disease of childhood, the emergence of drug-resistant bacteria has dramatically changed its clinical outcome. Here, we report the trend of AOM due to drug-resistant Staphylococcus pneumoniae (DRSP) and beta-lactamase-negative ampicillin-resistant Haemophilus influenzae (BLNAR), and the relation between antibiotics used for the management of AOM and the isolation of bacterial pathogens.


METHODS
Bacterial isolation and susceptibility tests were performed on specimens from children with AOM. Clinical information, including antibiotic treatment within the previous 30 days, was analyzed.


RESULTS
DRSP was detected in 59.3% of Pneumococci isolates and BLNAR in 26.0% of H. influenzae isolates. As expected, the incidence of AOM caused by such drug-resistant bacteria has been increasing year on year, and 32% of cases have been treated with inappropriate antibiotics. In contrast, 32% of cases of AOM caused by DRSP and 50% caused by BLNAR were given antibiotics with high susceptibility to drug-resistant bacteria.


CONCLUSIONS
In order to ensure the most appropriate use of antibiotics, clinicians should consider performing tympanocentesis or myringotomy, with subsequent submission of the middle ear fluid for susceptibility testing. Furthermore, these results suggest that, as well as the selection of antibiotics, the dosage and period of dosing should also be considered in the management of AOM. In addition, other factors, in particular horizontal transmission from other infants in day care or nursery school, may affect the rapid spread of such drug-resistant bacteria.
Sakakura
Koichi
K
Department of Otolaryngology--Head and Neck Surgery Gunma University Graduate School of Medicine, Japan.
Chikamatsu
Kazuaki
K
Furukawa
Michiyo
M
Shibasaki
Mayumi
M
Takegoshi
Tetsuo
T
Takahashi
Katsumasa
K
Furuya
Nobuhiko
N
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D005260:Female; D006193:Haemophilus influenzae / Q000187:drug effects*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D010033:Otitis Media / Q000188:drug therapy / Q000382:microbiology*; D018709:Statistics, Nonparametric; D013296:Streptococcus pneumoniae / Q000187:drug effects*
D000900:Anti-Bacterial Agents