Management of otitis media: 2000 and beyond.

BACKGROUND: In the next few years what will alter our modes of diagnosis, choice of therapies and strategies for prevention of acute otitis media (AOM)? These issues, as well as whether antibiotic resistance will continue to threaten the efficacy of currently available antimicrobial agents, whether industry and academia will be able to respond to bacterial resistance with effective new antimicrobial drugs and whether the pneumococcal conjugate vaccine will substantially reduce the incidence of AOM provide a basis for discussing the problems and possible solutions related to AOM. ANTIMICROBIAL DRUGS: Bacteria and viruses will continue to find ways to survive the activity of currently available antimicrobial drugs. Among the new antibacterial drugs under consideration are ketolides, oxazolodinones and quinolones. Guidelines stress limiting usage of antimicrobial agents to diseases that are likely caused by bacterial pathogens. Antiviral drugs are now available against influenza virus and respiratory syncytial virus infections. DIAGNOSIS: Tympanometry and/or acoustic reflectometry are adjunctive techniques for assisting in the diagnosis of middle ear effusion in children whose otoscopic examination is ambiguous. Laser myringotomy has been used in several hundred children; however, there are no published studies of randomized trials. NEW VACCINES: Investigators have evaluated the safety and efficacy of a heptavalent pneumococcal polysaccharide vaccine conjugated with CRM197 (a diphtheria toxin mutant). The results showed a reduction in the overall burden of severe and recurrent AOM. Respiratory syncytial virus is the viral pathogen most frequently associated with AOM. For this reason safe and effective viral vaccines are needed to complement the efficacy of bacterial vaccines for prevention of AOM.
CONCLUSIONS: Parents influence decisions by pediatricians to use antimicrobial agents and should be informed about the appropriate usage of antibiotics. Educators and public health officials must find techniques to distinguish WebSites that provide information of value from those that are not credible. Of paramount importance is the development of techniques to increase the accuracy of clinical and microbiologic diagnosis. Finally there is a need for studies of appropriate scientific design that can assess the efficacy and safety of alternative therapies.