The challenge of recalcitrant (difficult to treat, complicated) acute otitis media: epidemiology, treatment and prevention

Abstract

Although the microbiology of acute otitis media (AOM) is well defined, information on the bacteriological correlates of recurrent AOM (R-AOM) episodes is limited. Recently published studies based on data from double tympanocentesis analyses have revealed that most clinical cases of R-AOM are in fact new infections, and that most true bacteriological R-AOM episodes occur within 14 days of completing antibiotic therapy. Furthermore, lack of eradication of middle ear fluid and/or nasopharyngeal pathogens was shown to be associated with higher rates of clinical R-AOM, even if patients showed clinical improvement or complete resolution at the end of therapy. These recurrences are mostly caused by those pathogens not eradicated initially by antibiotic treatment. These recent data highlight the importance of bacteriological eradication in AOM, not only on clinical outcome but also in the prevention of RAOM episodes. Immunization with the 7-valent conjugate pneumococcal vaccine (PCV7) resulted in a major modification of AOM, characterized by a significant reduction in recurrent AOM cases and the cases requiring insertion of ventilation tubes, although the total number of AOM cases was not, at least initially, impressively reduced.