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Nontypeable H. influenzae main pathogen causing recurrent AOM
Nontypeable Haemophilus influenzae was the main otopathogen that caused bacteriologic relapses in children with acute otitis media treated with amoxicillin/clavulanate, according to recent study findings in The Pediatric Infectious Disease Journal.
“In our AOM research center and private practice, we don’t consider it ethical to prescribe amoxicillin as first-line therapy for AOM because we have shown that only 30% of the bacteria we isolate from tympanocentesis in initial AOM or [recurrent] AOM are susceptible to amoxicillin,” researchers wrote.
The prospective study included 66 pneumococcal conjugate vaccinated children aged 6 to 36 months who experienced recurrent AOM less than 1 month after completing amoxicillin/clavulanate therapy.
Researchers found that nontypeable H. influenzae (NTHi) accounted for 47% of initial AOMs and Streptococcus pneumoniae accounted for 15% (P<.0001). NTHi caused more recurrent AOMs than S. pneumoniae (42% vs. 24%, respectively).
NTHi that produces beta-lactamase and penicillin nonsusceptible S. pneumoniae was not more common in recurrent AOM than in initial AOM. Of 21 paired NTHi isolates genotyped, 61.9% were the same organism and 11.1% S. pneumoniae isolates were the same (P=.017). However, recurrent AOM that occurred within 1 week of stopping amoxicillin/clavulanate treatment was a different pathogen in 21% of cases, 33% in cases occurring 8 to 14 days later, 441% in cases occurring 15 to 21 days later and 57% in cases occurring 22 to 30 days later.
“Our findings support use of amoxicillin/clavulanate as the first-line antibiotic for AOM in pneumococcal conjugate vaccinated children,” researchers wrote.
Disclosure: The study was funded in part by NIH.
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