PNEUMONIAE OTITIS-MEDIA - LESSONS OF FAILURES

There has been an alarming worldwide increase in Streptococcus pneumoniae resistance to antibiotics, particularly penicillin, in recent years. It is in children, particularly those with acute otitis media (AOM), that the highest frequency of resistance is observed. S. pneumoniae is the main isolate in AOM, and otitis is the most frequent childhood pneumococcal infection. An epidemiologic surveillance network has been set up to monitor the involvement of PR S. pneumoniae in AOM treatment failures in Paris area. A total of 293 children presenting to 12 ear, nose and throat (ENT) specialists were included in the study. Bacteriological sampling demonstrated that in 146 cases (49,8%), no pathogen was present at the time of treatment failure. In the remaining patients S. pneumoniae was the most frequently recovered pathogen, being isolated from 81/147 (55,1%) of bacteriologically documented cases. Serotype 23F was the predominant strain, representing 53% of all S. pneumoniae isolates recovered. Resistance or reduced susceptibility to the prescribed antibiotic was seen in 70/81 (86,4%) of the S. pneumoniae isolates. Amoxycillin seemed to be the most active oral beta-lactam against these pathogens. It seems to exist a correlation between low serum inhibitory quotient and failures. The multiresistance of S. pneumoniae poses a serious therapeutic problem and should make myringotomy and bacteriological sampling obligatory in cases of antibiotic treatment failure.