TREATMENT FAILURE IN OTITIS-MEDIA - AN ANALYSIS

An epidemiological study was conducted in order to monitor the involve ment of penicillin-resistant pneumococci (PRP) in treatment failure in acute otitis media (AOM), in an area of France where resistance to an tibotics is high. A total of 293 children presenting to 12 ear, nose a nd throat (ENT) specialists were included in the study. The mean age o f the patients was 15.3 months and most of the children (58.7%) were a ttending day care centres. Bacteriological sampling demonstrated that in 146 cases (49.8%), no pathogen was present at the time of treatment failure. In the remaining patients Streptococcus pneumoniae was the m ost frequently recovered pathogen, being isolated from 81/147 (55.1%) of bacteriologically documented cases. Serotype 23F was the predominan t strain, representing 53% of all S. pneumoniae isolates recovered. Re sistance or reduced susceptibility to the prescribed antibiotic was se en in 70/81 (86.4%) of the S. pneumoniae isolates. In 32 out of 49 chi ldren administered a beta-lactam antibiotic, treatment failure involve d PRP. Amoxycillin seemed to be the most active oral beta-lactam again st these pathogens. The multiresistance of S. pneumoniae poses a serio us therapeutic problem and should make myringotomy and bacteriological sampling obligatory in cases of antibotic treatment failure.