Management of otitis media: 2000 and beyond

Background. In the next few years what will alter our modes of diagnosis, c hoice of therapies and strategies for prevention of acute otitis media (AOM )? These issues, as well as whether antibiotic resistance will continue to threaten the efficacy of currently available antimicrobial agents, whether industry and academia will be able to respond to bacterial resistance with effective new antimicrobial drugs and whether the pneumococcal conjugate va ccine will substantially reduce the incidence of AOM, provide a basis for d iscussing the problems and possible solutions related to AOM. Antimicrobial drugs. Bacteria and viruses will continue to find ways to sur vive the activity of currently available antimicrobial drugs. Among the new antibacterial drugs under consideration are ketolides, oxazolodinones and quinolones. Guidelines stress limiting usage of antimicrobial agents to dis eases that are likely caused by bacterial pathogens. Antiviral drugs are no w available against influenza virus and respiratory syncytial virus infecti ons. Diagnosis. Tympanometry and/or acoustic reflectometry are adjunctive techni ques for assisting in the diagnosis of middle ear effusion in children whos e otoscopic examination is ambiguous, Laser myringotomy has been used in se veral hundred children; however, there are no published studies of randomiz ed trials. New vaccines, Investigators have evaluated the safety and efficacy of a hep tavalent pneumococcal polysaccharide vaccine conjugated with CRM197 (a diph theria toxin mutant), The results showed a reduction in the overall burden of severe and recurrent AOM, Respiratory syncytial virus is the viral patho gen most frequently associated with AOM. For this reason safe and effective viral vaccines are needed to complement the efficacy of bacterial vaccines for prevention of AOM. Conclusions. Parents influence decisions by pediatricians to use antimicrob ial agents and should be informed about the appropriate usage of antibiotic s. Educators and public health officials must find techniques to distinguis h Web-Sites that provide information of value from those that are not credi ble, Of paramount importance is the development of techniques to increase t he accuracy of clinical and microbiologic diagnosis. Finally there is a nee d for studies of appropriate scientific design that can assess the efficacy and safety of alternative therapies.