The microbiology of otitis media has been carefully elucidated by numerous studies.8-12 However, with the increased use of antimicrobial agents, the emergence of resistant bacteria has become a significant problem related to otitis media. Data from studies performed by Bluestone and Klein9 demonstrate that Streptococcus pneumoniae remains the primary bacterial cause of otitis media, followed by Haemophilus (38%), Haemophilus influenzae (27%), and Moraxella caterrhalis (10%). In this same study, 28% demonstrated no bacteria or nonpathogenic bacteria. Approximately 30 to 40% of patients with acute otitis media demonstrate respiratory viruses that may be present in combination with bacterial pathogens.13 Respiratory syncytial virus has recently been implicated as a major viral pathogen in otitis media.14 In recent years, the incidence of resistant bacteria has increased in cases of otitis media. First noted was the advent of b-lactamase-producing Haemophilus influenzae and Moraxella caterrhalis. More recently, the incidence of penicillin-resistant pneumococci has increased.15 The resistance mechanism for each of these resistance types is quite different. Studies performed throughout the 1990s have demonstrated increased incidence of resistance by both b-lactamase-producing bacteria and Streptococcus pneumonia.is'2<0 The increased prevalence of bacterial resistance may alter the way we treat otitis media in children, with respect to both antimicrobial therapy and surgical intervention.
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