To the Editor Frost and Hersh argue that nearly 75% of antibiotics used for the treatment of acute otitis media (AOM) may be unnecessary. Their position hinges on a review article that quotes a study conducted 50 years ago, which they claim shows that symptoms in children with AOM caused by Hemophilus influenzae or Moraxella catarrhalis are more likely to resolve spontaneously without treatment compared with symptoms in children with Streptococcus pneumoniae. However, as all children in the above study had tympanocentesis at entry, its data cannot be used to estimate spontaneous resolution rates. More recent data suggest that H influenzae, not S pneumoniae, is more likely to be recovered from middle ears of children experiencing treatment failure. In our recent placebo-controlled trial, failure rates were unrelated to the pathogen colonizing the nasopharynx at the time of diagnosis. However, in our 10 vs 5 trial, children with H influenzae in their nasopharynx at time of diagnosis were significantly more likely to have treatment failure than children with S pneumoniae. The authors also cite a Rochester study demonstrating decreasing S pneumoniae and more H influenzae and M catarrhalis in middle ear fluid of children with AOM. However, more recent studies from this same group show a reversal in that trend, with replacement of vaccine-susceptible S pneumoniae with non–vaccine susceptible serotypes.
Clinical Practice Guidelines
