Acute otitis media in children: Current epidemiology, microbiology, clinical manifestations, and treatment

An accurate differential diagnosis of AOM is essential for ensuring appropriate treatment, since overdiagnosis of disease is common and antibiotics are not indicated for otitis media with effusion. Although antibiotic therapy is required in only 20-30% of all AOM cases (high rate of spontaneous recovery), most of the patients are treated since this small proportion cannot be quickly and easily identified. The main determinant of the efficacy of antibiotics in AOM is the time that drug concentration at the site of infection exceeds the minimal inhibitory concentration for the pathogen. The major problems encountered in the antibiotic therapy of AOM are the tremendous increase in the resistance to antibiotics of its main pathogens and the lack of tight criteria in the selection of the appropriate antibiotic drugs for the treatment of this disease. The recently published Center for Disease Control and Prevention (CDC) guidelines for the treatment of AOM represent a major step forward in the rational approach to the management of this disease by establishing a clear hierarchy among the various therapeutic agents used in the treatment of simple and complicated AOM. A seven-valent pneumococcal conjugate vaccine recently licensed in the United States for universal immunization of infants <2 years has demonstrated efficacy for prevention of serotype-specific pneumococcal AOM.