Otitis media complications and treatment failures: implications of pneumococcal resistance.

Classic complications of untreated otitis media include meningitis, lateral sinus thrombosis and chronic suppurative otitis media. In the past, in countries where otitis media is usually treated, complications have been rare, because of the good activity of almost all orally administered antibiotics against the most common cause of complications, Streptococcus pneumoniae. Treatment failures were usually caused by beta-lactamase-producing nontypable Haemophilus influenzae or by Moraxella (Branhamella) catarrhalis and were rarely associated with serious systemic infections. With the advent of multidrug-resistant pneumococci, however, serious and fatal infections can occur in the face of our most potent antimicrobial agents. The consequences of the emergence of multidrug-resistant pneumococci are likely to include more persistent purulent otitis media, increased usage of broad-spectrum antibiotics, an increase in surgical treatment rates for otitis media and, eventually, an increase in suppurative complications of otitis media. Medical treatment failures probably already surpass eustachian tube dysfunction as the most common reason for tympanostomy tube insertion. Multidrug-resistant pneumococci may be expected to change the way in which primary and secondary care is currently administered.