STATUS OF STREPTOCOCCUS-PNEUMONIAE RESIST ANCE TO PENICILLIN-G IN CURRENT BACTERIOLOGICAL EPIDEMIOLOGY OF OTITIS-MEDIA IN CHILDREN

Between 1st january 1992 and 15 april 1993, we send 664 samples of pus from cases of otitis media to the Microbiology Laboratory of the Trou sseau Hospital. Of these, 491 gave positive results, (352 bacteries) w hile the remaining 26,1 % were negative (i.e. sterile) when cultivated . The main bacteria were : Haemophilus influenzae 48 % (28 % beta-lact amase+), Streptococcus pneumoniae 30 % (14 % sensitive to Penicillin), Pseudomonas aeruginosa 7 %, Staphylococcus aureus 9 %. 104 pneumococc i were isolated (30 % of the micro organisms found), of which 54 exhib ited decreased sensitivity to Penicillin, i.e. 52 % of the pneumococci isolated. The MIC of 47 of these pneumococci exceeded 1 mg/l and they were therefore resistant to Penicillin G (45 %). As E.N.T. specialist s, our concern was to evaluate the extent of pneumococci resistance (M IC > 1 mg/l) in relation to the characteristics of the otitis examinat ed, whether initial acute otitis media, relapsing acute otitis media, or lingering otitis. In these diseases, the percentage of resistant pn eumococci (MIC > 1 mg) showed a regular increase as the number of rela pses and then the chronicity of the otitis increased, such that 50 % o f the pneumococci isolated during the 1 st trimester of 1993 were resi stant. The therapeutic approach adopted in our Department is to increa se the dosage of Amoxicillin (150 mg/kg/d) and combine it with Rifampi n (20 mg/kg/d) during initial treatment.