Abstract
Objective
Describe cases of non-responsive otitis media and rhinosinusitis due to highly resistant strains of Streptococcus pneumoniae.
Methods
Resistant strains of Streptococcus pneumonia were isolated from cases of non-responsive pediatric otitis media or rhinosinusitis, from September 2005 to September 2008, from a single pediatric otolaryngology practice. Children had failed therapy with “high dose” amoxicillin-clavulanate and/or ceftriaxone injections.
Results
54 cases of apparent failed therapy were detected. The strain(s) demonstrated in vitro high level resistance to penicillin, amoxicillin-clavulanate, oral cepahalosporins, trimethoprim-sulfamethoxazole, macrolides, and clindamycin; and were intermediately or fully resistant to ceftriaxone. Serotyping of representative isolated demonstrated these to be 19A pneumococcal isolates. These cases were often in unusually young infants, and often were from a single prolonged episode of acute otitis medi, including 2 cases of mastoiditis with subperiostial abscess. Most of the cases were identified by office-based diagnostic tympanocentesis and were rarely isolated from children undergoing tympanstomy tube placement. All cases resolved after therapy with levofloxacin pediatric suspension (25 mg/ml, 20 mg'kg/day divided BID.
Conclusions
This is the largest series of otitis and sinusitis cases due to these highly resistant organisms; and these cases suggest that resistant pneumoccocci are likely causing a significant number of treatment failures in the U.S. They are not detected unless nasal or middle ear cultures are taken from treatment failures. Treatment with fluoroquinolones is effective, but raises issues concerning the role of this class of anitbiotics in children.
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