Abstract
A regional surveillance study was carried out in children with recurrent acute otitis media (AOM) to determine the antimicrobial susceptibility of three common AOM pathogens. Susceptibility to relevant antimicrobial agents was determined on 149 Streptococcus pneumoniae, 246 Haemophilus influenzae and 119 Moraxella catarrhalis strains isolated between January 1999 and January 2002, either from the nasopharynx or middle ear of 74 children with recurrent AOM, the majority (77%) being otitis-prone. Overall pneumococcal resistance to penicillin was 9.4% (6.7% penicillin-intermediate resistant, 2.7% penicillin-resistant), whereas cotrimoxazole and erythromycin resistance accounted for 25.5% and 38.9% respectively. The prevalence of antimicrobial-non-susceptible S. pneumoniae was the highest in middle ear isolates (P<0.05) and in otitis-prone children (P<0.01). Moreover, otitis-prone children harboured significantly more pneumococci resistant to at least two antimicrobial agents (24.3% versus 7.4%; P<0.01). No patient age related variation was observed. Five serogoups (6, 19, 23, 14 and 9) covered by the 7-valent pneumococcal conjugate vaccine, constituted most of the antibiotic resistant pneumococci. Among nasopharyngeal and middle ear H. influenzae isolates, 17.1% were resistant to ampicillin and 16.3% to cotrimoxazole. For M. catarrhalis, 92.4% of all isolates was ampicillin-resistant. Conclusion: this study confirms international and national differences in antimicrobial susceptibility profiles of three acute otitis media pathogens with relatively favourable antibiotic resistance rates in Belgian children with frequent acute otitis media. This “at risk” population of otitis-prone children is shown to harbour more antimicrobial resistant and multidrug resistant pneumococci. If antimicrobial therapy in this group of children is indicated, high dose amoxicillin is recommended whereas the use of macrolides is obsolete.
Similar content being viewed by others
Abbreviations
- AOM :
-
acute otitis media
- MEF :
-
middle ear fluid
- MIC :
-
minimal inhibitory concentration
References
Abdel-Haq N, Abuhammour W, Asmar B, Thomas R, Dabbagh S, Gonzalez R (1999) Nasopharyngeal colonization with Streptococcus pneumoniae in children receiving trimethoprim-sulfamethoxazole prophylaxis. Pediatr Infect Dis J 18: 647–649
Bogaert D, Engelen MN, Timmers-Reker AJM, Elzenaar KP, Peerbooms PGH, Coutinho RA, de Groot R, Hermans PWM (2001) Pneumococcal carriage in children in The Netherlands: a molecular epidemiological study. J Clin Microbiol 39: 3316–3320
Borres MP, Alestig K, Krantz I, Larsson P, Norvenius G, Stenqvist K (2000) Carriage of penicillin-susceptible and non-susceptible pneumococci in healthy young children in Goteborg, Sweden. J Infect Dis 40: 141–144
Del Mar CB, Glasziou PB, Hayem M (1997) Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ 314: 1526–1529
Dhooge IJM, Albers FWJ, Van Cauwenberge PB (1999) Intratemporal and intracranial complications of acute suppurative otitis media in children: renewed interest. Int J Pediatr Otorhinolaryngol 49: S109–S114
Hausdorff WP, Yothers G, Dagan R, Kilpi T, Pelton SI, Cohen R, Jacobs MR, Kaplan SL, Levy C, Lopez EL, Mason EO Jr, Syriopoulou V, Wynne B, Bryant J (2002) Multinational study of pneumococcal serotypes causing acute otitis media in children. Pediatr Infect Dis J 21: 1008–1016
Hoban DJ, Doern GV, Fluit AC, Roussel-Delvallez M, Jones RN (2001) Worldwide prevalence of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in the SENTRY antimicrobial surveillance program, 1997–1999. Clin Infect Dis 32: S81–S93
Jacobs MR, Dagan R, Appelbaum PC, Burch DJ (1998) Prevalence of antimicrobial-resistant pathogens in middle ear fluid: multinational study of 917 children with acute otitis media. Antimicrob Agents Chemother 42: 589–595
Jacobs MR, Bajaksouzian S, Zilles A, Lin G, Pankuch GA, Appelbaum PC (1999) Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 oral antimicrobial agents based on pharmacodynamic parameters: 1997 U.S. Surveillance Study. Antimicrob Agents Chemother 43: 1901–1908
Joki-Erkkila VP, Aittoniemi J, Vuento R, Puhakka H (2002) β-Lactamase-producing Moraxella catarrhalis may prevent the emergence of penicillin-resistant Streptococcus pneumoniae in children with recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 63: 219–222
Joloba ML, Windau A, Bajaksouzian S, Appelbaum PC, Hausdorff WP (2001) Pneumococcal conjugate vaccine serotypes of Streptococcus pneumoniae isolates and the antimicrobial susceptibility of such isolates in children with otitis media. Clin Infect Dis 33: 1489–1494
Leach AJ, Shelby-James TM, Mayo M, Gratten M, Laming AC, Currie BJ, Matthews JD (1997) A prospective study on the impact of community-based azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae. Clin Infect Dis 24: 356–362
Manninen R, Huovinen P, Nissinen A (1997) Increasing antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in Finland. J Antimicrob Chemother 40: 387–392
Marchisio P, Claut L, Rognoni A, Esposito S, Passali D, Bellussi L, Drago L, Pozzi G, Mannelli S, Schito G, Principi N (2003) Differences in nasopharyngeal bacterial flora in children with non-severe recurrent acute otitis media and chronic otitis media with effusion: implications for management. Pediatr Infect Dis J 22: 262–268
Mbelle N, Huebner RE, Wasas AD, Kimura A, Chang I, Klugman KP (1999) Immunogenicity and impact on nasopharyngeal carriage of a nonavalent pneumococcal conjugate vaccine. J Infect Dis 180: 1171–1176
National Committee for Clinical Laboratory Standards (2000) Performance standards for antimicrobial disk susceptibility tests, 7th edn. Approved Standard (M2-A7) National Committee for Clinical Laboratory Standards,Wayne
Pons JL, Mandement MN, Martin E, Lemort C, Nouvellon M, Mallet E, Lemeland JF (1996) Clonal and temporal patterns of nasopharyngeal penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae strains in children attending a day care center. J Clin Microbiol 34: 3218–3222
Sahm DF, Jones ME, Hickey ML, Diakun DR, Mani SV, Thornsberry C (2000) Resistance surveillance of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated in Asia and Europe, 1997–1998. J Antimicrob Chemother 45: 457–466
Sá-Leão R, Tomasz A, Sanches IS, Nunes S, Alves CR, Avo AB, Saldanha J, Kristinsson KG, de Lencastre H (2000) Genetic diversity and clonal patterns among antibiotic-susceptible and -resistant Streptococcus pneumoniae colonizing children: day care centers as autonomous epidemiological units. J Clin Microbiol 38: 4137–4144
Syrogiannopoulos GA, Katopodis GD, Grivea IN, Beratis NG (2002) Antimicrobial use and serotype distribution of nasopharyngeal Streptococcus pneumoniae isolates recovered from Greek children younger than 2 years old. Clin Infect Dis 35: 1174–1182
Vaneechoutte M, Verschraegen G, Claeys G, Flamen P (1988) Rapid identification of Branhamella catarrhalis with 4-methylumbelliferyl butyrate. J Clin Microbiol 26: 1227–1228
Vaneechoutte M, Verschraegen G, Claeys G, van den Abeele AM (1988) Selective medium for Branhamella catarrhalis, with acetazolamide as a specific inhibitor of Neisseria spp. J Clin Microbiol 26: 2544–2548
Verhaegen J (2000) Resistance surveillance of Streptococcus pneumoniae in Belgium. National Report, Scientific Institute of Public Health, Brussels
Verhaegen J, Glupczynski Y, Verbist L, Blogie M, Verbiest N, Vandeven J, Yourassowsky E (1995) Capsular types and antibiotic susceptibility of pneumococci isolated from patients with serious infections, 1980–1993. Clin Infect Dis 20: 1339–1345
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
van Kempen, M.J.P., Vaneechoutte, M., Claeys, G. et al. Antibiotic susceptibility of acute otitis media pathogens in otitis-prone Belgian children. Eur J Pediatr 163, 524–529 (2004). https://doi.org/10.1007/s00431-004-1475-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-004-1475-0