Controversies in the medical management of persistent and recurrent acute otitis media - Recommendations of a clinical advisory committee

Streptococcus pneumoniae is the predominant bacterial pathogen associated w ith acute otitis media (AOM), causing an estimated 7 million cases annually in the United States. Bacterial resistance should be considered when selec ting an antimicrobial agent for otitis media. Significant increases in drug -resistant S pneumoniae are documented worldwide, and less than 50% of S pn eumoniae strains are fully susceptible to penicillin in some regions of the United States. Although amoxicillin is recommended for uncomplicated AOM. treatment guidelines should be flexible and adaptable, taking into consider ation local and regional susceptibility patterns, the age of the patient, t he frequency of prior infections, and the response to prior therapy. Resist ant organisms are more prevalent in children younger than 2 years of age an d in those who have recurrent or persistent AOM. Overdiagnosing AOM, select ing inappropriate empiric therapy, or both, leads to overuse and misuse of antibiotics and causes increased drug resistance. This article reviews pers istent and recurrent AOM and discusses the pitfalls of diagnosis and the pr actical limitations of current treatment recommendations.