Ear Infections and Bacterial Resistance

The most common cause of fever is an acute ear infection or acute otitis media. Acute Otitis media can be caused by a number of different bacteria. The most common are: Streptococcus Pneumonia, Heamophilus Influenzae (this is not the flu virus), Moraxella catarrhalis. Less commonly, Mycoplasma Pneumoniae, Streptococcus Pyogenes, Staphylococcus Aureus along with other bacteria and viruses. Antibiotic resistance is not commonly seen in S. Pyrogenesis but is developing rapidly in S. Pneumonia and H. Influenza. The bacterial resistance in S. Pneumonia is transmitted on a plasmid between the bacteria. A single plasmid can carry the genes for resistance to both the penicillin and macrolide antibiotics. The mechanism of penicillin resistance in this organism is by producing a penicillin binding protein and not by producing penicillinase (an enzyme which breaks down penicillin). Thus, this organism will also be resistant to Amoxcillin/Clavulanate and Amoxcillin/Sulbactam. The mechanism of penicillin resistance in H. Influenzae is by the production of a B-lactamase which breaks down penicillin. In this case, Amoxcillin/Clavulanate would be expected to be an effective.

Acute otitis media: management and surveillance in an era of pneumococcal resistance--a report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group.

Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media: Recommendations of a Clinical Advisory Committee.

Patient Suggestion For Adults with a Middle Ear Infection (Otitis Media): Ask your doctor if a generic medication may be able to treat your condition at a lower cost. For example:

A discount pharmacy was consulted on Nov 20, 2007 (prices used in this example may change and vary).
1) A 10 day supply of Augmentin XR taken two tablets twice a day for 10 days cost $139.94. A similar dosage can be obtained by taking generic Augmentin 875 mg every twelve hours alternating with Amoxicillin 1000 mg every twelve hours. These dosages are alternated every size hours. Thus, a total of four doses of antibiotics are taken each day. Augmentin 875, Amoxicillin, Augmentin 875 and Amoxicillin. The total cost of this medication regiment is $66.98 a savings of $72.96.

Left untreated 50% of all cases of otitis media will clear without antibiotics, but 1 in 400 will progress to acute coalescent mastoiditis, a life threatening ear infection; and rarely meningitis, a life threatening brain infection, can occur. ***Learn More About Acute Coalescent Mastoiditis***

Ways to help prevent Ear Infections

	No pacifiers after 1 year of age
	No smoking
	Supine sleeping position
	No bottle propping
	Do not give a bottle in bed
	No day care
	Breast feed

Articles on Bacterial Resistance

	NIH Statement of Bacterial Antibiotic Resistance
	Bacteriologic efficacies of oral azithromycin and oral cefaclor in treatment of acute otitis media in infants and young children
	Acute otitis media: management and surveillance in an era of pneumococcal resistance--a report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group
	Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 oral antimicrobial agents based on pharmacodynamic parameters: 1997 U.S. Surveillance study.
	Bacteriologic and clinical efficacy of amoxicillin/clavulanate vs. azithromycin in acute otitis media
	Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group.

Vaccines: H.Flue vaccine has dramatically reduced the incidence of infection to H. Influenza Type B. A new vaccine Prevnar is a heptavalent Pneumococcal Vaccine to Streptococcus Pneumonia. S. Pneumonia is a common cause of otitis media. Unfortunately, many children who have recurrent otitis media may have already been exposed to many of the various types of S. Pneumonia which Prevnar vaccinates for. Often the main problem in children with chronic otitis media, is not that they do not have antibodies to the bacteria but that they have eustachian tube dysfunction. The effectiveness of Prevnar in children who already have recurrent otitis media needs more study.
Overall, in one study it was shown that Prevnar reduced the rate of office visits for otitis media by 7% and the placement of myringotomy tubes by 20%. Recommended Vaccination Schedules Read More About Prevnar
Go To Prevnar's Home Page

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Page last updated 05/07/2008

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