Management of Pediatric Otitis Media

Ann McMahon Wicker, PharmD, BCPS; Brice Labruzzo Mohundro, PharmD

Disclosures

US Pharmacist 

In This Article

Microbiology

Streptococcus pneumoniae,Haemophilus influenzae, and Moraxella catarrhalis are the most common pathogens isolated from AOM, according to studies.[5,7] When middle-ear fluid was examined, S pneumoniae,H influenzae, and M catarrhalis were found 25% to 35%, 15% to 30%, and 3% to 20% of the time, respectively.[7] Evidence suggests that microbiology may be changing owing to routine vaccination with the heptavalent pneumococcal vaccine; research revealed an increase in H influenzae isolates from 39% to 52% in children aged 7 to 24 months and a decrease in S pneumoniae from 49% to 34% between 1992 and 1998 and between 2000 and 2003.[7] Although rare, other pathogens that may be present in AOM include group A streptococcus (GAS), Staphylococcus aureus, anaerobic organisms, Gram-negative bacilli, viruses, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Chlamydia trachomatis (in infants <6 months). S pneumoniae, H influenzae, M catarrhalis, GAS, and S aureus also are responsible for recurrent and persistent OM.[7] The bacterial pathogens associated with OME are the same as those seen in AOM. In CSOM, however, Pseudomonas aeruginosa, S aureus, Proteus mirabilis, and Klebsiella species are the most common pathogens isolated, and mixed infections are common. It is important to note that multidrug antibiotic resistance is common with Pseudomonas infections.[5,9]

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