Format

Send to

Choose Destination
Int J Pediatr Otorhinolaryngol. 2019 Aug;123:102-109. doi: 10.1016/j.ijporl.2019.04.041. Epub 2019 May 6.

A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media.

Author information

1
Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK; Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK.
2
Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
3
Department of Microbiology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK.
4
Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK.
5
Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK; Institute of Health and Society, Newcastle University, Richardson Road, Newcastle Upon Tyne, NE2 4AX, UK.
6
Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK; Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK. Electronic address: jason.powell@newcastle.ac.uk.

Abstract

OBJECTIVE OF REVIEW:

Acute otitis media (AOM) is the largest cause of antimicrobial prescriptions amongst children in developed countries. Excessive and inappropriate prescribing is known to drive antimicrobial resistance, but less is known of antimicrobial resistance in AOM-associated bacteria.

TYPE OF REVIEW & SEARCH STRATEGY:

We conducted a systematic review and meta-analysis of bacterial prevalence and antimicrobial resistance in studies of paediatric AOM identified from Ovid Medline, Embase and the Cochrane library.

RESULTS:

From 48 unique studies, 15,871 samples were included. Only 0.67 (CI 0.63-0.71) of all ear samples grew a bacterial pathogen. The most common bacterial causes of AOM in children were Streptococcus pneumoniae 0.30 (CI 0.27-0.32), Haemophilus influenza 0.23 (CI 0.20-0.26), and Moraxella catarrhalis 0.05 (CI 0.04-0.06). Resistance patterns varied amongst organisms and antimicrobial agents. The pooled proportion of bacterial culture-positive episodes of AOM that could be effectively treated with amoxicillin was 0.85 (CI 0.76-0.94), erythromycin was 0.64 (0.48-0.78) and amoxicillin-clavulanate was 0.95 (CI 0.85-0.98).

CONCLUSION:

We have demonstrated the bacteriology and antimicrobial resistance patterns of AOM. Of samples which grew bacteria, on average approximately 15% of isolates demonstrated resistance to amoxicillin; a typical first-line agent. Greater understanding of local bacteriology and resistance patterns is needed to enable improved antimicrobial stewardship.

KEYWORDS:

Antimicrobial resistance; Bacteriology; Otitis media

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center