Antibiotic therapy for otitis media

Abstract

The management of otitis media in this era of increasing antimicrobial resistance poses a clinical challenge to the pediatrician. Amoxicillin continues to be the drug of choice for first-line therapy. Several compounds represent second-line therapy, which must be effective against nonsusceptible Streptococcus pneumoniae , as well as β-lactamasepositive, ampicillin-resistant Haemophilus influenzae and Moraxella catarrhalis . Reevaluation of traditional therapy and chemoprophylaxis for acute otitis media (AOM) is an important aspect of judicious antimicrobial use, the focus of an overall strategy to deal with the emergence of resistance. Components of such a program include the appropriate diagnosis and management of AOM and otitis media with effusion, short-course (5–7 day) therapy for AOM, and restrictive criteria that limit continuous prophylaxis for recurrent AOM. Although the available 23-valent polysaccharide pneumococcal vaccine does not protect against otitis media, the efficacy of protein-conjugate pneumococcal vaccines in the prevention of AOM in young children is being evaluated in clinical trials.