title: Pathogen shifts and changing cure rates for otitis media and tonsillopharyngitis.
abstract: Pneumococcal conjugate vaccine use has caused a decrease in the incidence of recurrent and refractory acute otitis media in the United States and a shift in the predominant pathogens. Now Haemophilus influenzae is the most commonly isolated organism (about 60% of the total), and more than half the strains make beta-lactamase, rendering them resistant to amoxicillin. Penicillin nonsusceptible pneumococci, the main target of antibiotic therapy in the 1990s, has become a much less common isolate (10%- 25% of the total). These changes impact antibiotic selection for acute otitis media. Penicillin treatment of group A streptococcal tonsillopharyngitis does not meet the minimum United States Food and Drug Administration standards for first-line treatment, which is 85% or greater eradication at the end of therapy. Recent results with amoxicillin suggest its efficacy is also waning. Cephalosporins have the highest bacteriologic and clinical efficacy. This has implications for optimal antibiotic therapy.
authors.affiliation: Department of Microbiology and Immunology, Pediatrics and Medicine, University of Rochester Medical Center, Elmwood Pediatric Group, Rochester, New York 14642, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Pichichero
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D006193:Haemophilus influenzae / Q000187:drug effects / Q000472:pathogenicity; D006801:Humans; D010033:Otitis Media / Q000188:drug therapy / Q000382:microbiology*; D010406:Penicillins / Q000009:adverse effects; D010612:Pharyngitis / Q000188:drug therapy / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000187:drug effects; D014069:Tonsillitis / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins