PNEUMONIAE OTITIS-MEDIA - LESSONS OF FAIL URES

There has been an alarming worldwide increase in Streptococcus pneumon iae resistance to antibiotics, particularly penicillin, in recent year s. 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 treatmen t failures in Paris area. A total of 293 children presenting to 12 ear , nose and throat (ENT) specialists were included in the study. Bacter iological sampling demonstrated that in 146 cases (49,8%), no pathogen was present at the time of treatment failure. In the remaining patien ts S. pneumoniae was the most frequently recovered pathogen, being iso lated from 81/147 (55,1%) of bacteriologically documented cases. Serot ype 23F was the predominant strain, representing 53% of all S. pneumon iae isolates recovered. Resistance or reduced susceptibility to the pr escribed antibiotic was seen in 70/81 (86,4%) of the S. pneumoniae iso lates. Amoxycillin seemed to be the most active oral beta-lactam again st 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 b acteriological sampling obligatory in cases of antibiotic treatment fa ilure.