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growing antibiotic resistance globally may lead to a rise in the number of AOM
complications [23]. The incidence of AM in our
hospital district has increased relative to earlier data. Different
pathogens cause different clinical findings of AM.
It is important to take bacterial cultures of the middle ear
effusion and to treat the patients according to these results. In our
subject pool, older children had more previous antibiotic
treatment (p = 0.05). This partially explains the tendency towards
more culture-negative findings.
We compared our data with the data published by Leskinen
et al. [9] The patients in their study comprised children (015
years) treated for AOM complications at Helsinki University
Central Hospital, Department of Otorhinolaryngology, between
1990 and 2000. The incidence of complications was higher in our
material (1.88 vs. 1.1/100 000/year). S. pneumoniae (38% vs. 25%)
and S. pyogenes (11% vs. 6%) were more common, but P. aeruginosa
less common (11% vs. 22%) in our material. Mastoidectomy was
more common in the earlier material (55% vs. 34%). The subject
pools were otherwise similar, but differed in the number of 16year-olds (2 in our study) and in complications other than AM (3%
in their study).
S. pneumoniae is known to be the predominant pathogen in
children with AM [16,24]. Our results support this finding. S.
pneumoniae wasmore common in younger than in older children. Of
the typical AOMpathogens, S. pneumoniae has been associated with
the greatest virulence [12,14]. Otalgia and retroauricular symptoms
were common in patients with S. pneumoniae. Otorrhoea was less
common (p = 0.03) in patients with S. pneumoniae than in patients of
other pathogen groups. Patients with S. pneumoniae had more
destruction of the mastoid septa (p = 0.05) relative to all other
pathogen groups.Mastoidectomy was performed in 34% of all cases,
most commonly in patients with S. pneumoniae I/R.
Resistance problems of S. pneumoniae to penicillin and
cefalosporines have been reported in several countries including
the United States [15,16] and European countries [4]. However, in
a recent Swedish study of AM patients, S. pneumoniae with
reduced sensitivity to beta-lactam antibiotics was found in less
than 1% of the patients [8]. In our patients, 48% of the S.
pneumoniae had reduced susceptibility to penicillin or cefalosporines
(I or R). These bacteria were even more common in
younger children. Only 30% of them were totally resistant to
penicillin but 50% to 1st and 2nd generation cefalosporins.
(Table 4) The Swedish guidelines for diagnosis and treatment of
AOM introduced in 2000 propose watchful waiting as a treatment
option in healthy 216 year-old children with uncomplicated
AOM [3]. The Finnish guidelines mention this option but do not
suggest it as strongly. (Table 1) It is possible that this influences
the resistance situation in Finland. The prevention of otitis media
with vaccines is a promising approach to diminish the disease