Otitis media: re-evaluation of diagnosis and treatment in the era of antimicrobial resistance, pneumococcal conjugate vaccine, and evolving morbidity.
The changing susceptibility of bacterial otopathogens is only one aspect of the evolving concepts regarding pathogenesis, immunoprophylaxis, pharmacodynamics, and sequelae of acute otitis media that mandates new insights for achieving a successful outcome. 2004 guidelines by the American Academy of Pediatrics for the treatment of acute otitis media provide one perspective that proposes a rethinking of the routine use of antimicrobial therapy with the hope of preventing further increases in bacterial resistance among otopathogens. The goals of this article are to incorporate the advances in diagnosis, treatment, prevention, and management of sequelae into strategies that optimize the outcome of acute otitis media and limit further emergence of resistant otopathogens.
Pelton
Stephen I
SI
Departments of Pediatrics and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, MA 02118, USA. spelton@bu.edu
D000208:Acute Disease; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D003663:Decision Trees; D003937:Diagnosis, Differential; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D006801:Humans; D008826:Microbial Sensitivity Tests; D008876:Middle Ear Ventilation; D009017:Morbidity; D010033:Otitis Media / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D010372:Pediatrics / Q000379:methods; D022242:Pneumococcal Vaccines; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000379:methods; D012008:Recurrence; D012307:Risk Factors; D012703:Serotyping; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014611:Vaccination / Q000379:methods; D018074:Vaccines, Conjugate
D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate