Oral β-lactams in the treatment of acute otitis media

Acute otitis media (AOM) is an important infectious disease among children throughout the world. The management of AOM is complicated by difficulties in diagnosis, spontaneous resolution, altered microbiology after pneumococcal conjugate vaccine use, and expanding antimicrobial resistance. The recent introduction of the heptavalent pneumococcal vaccine has resulted in a decrease in AOM due to penicillin-nonsusceptible strains of Streptococcus pneumoniae (PNSP) and an increase in infection due to β-lactamase–positive nontypeable Haemophilus influenzae. The results of in vitro susceptibility testing in the context of broad surveillance programs provide useful information regarding the potency and spectrum of the oral β-lactam antibacterial agents used in the treatment of AOM. The application of pharmacokinetic/pharmacodynamic breakpoints provides an effective means of projecting the potential clinical efficacy of the available agents. In view of what appears to be an increase prominence of β-lactamase–positive Gram-negative AOM pathogens and a decrease in PNSP, it appears that empiric therapy for AOM should now include an agent with activity against β-lactamase–positive H. influenzae and S. pneumoniae.