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Acute otitis media and pneumococcal resistance: making judicious management decisions.

The emergence of drug-resistant Streptococcus pneumoniae (DRSP) has implications for the primary care provider who treats acute otitis media (AOM) in children. AOM must be carefully distinguished from otitis media with effusion (OME). Antibiotic treatment for AOM is recommended because of the low rate of spontaneous resolution of S. pneumoniae infection and the risk of suppurative complications, particularly in young children. Amoxicillin continues to be the first drug of choice. Children for whom the first course of antibiotics fails should be treated with amoxicillin-clavulanate, cefuroxime axetil, or ceftriaxone. Trimethoprim-sulfamethoxazole, the macrolides, and most of the cephalosporins have limited effectiveness against DRSP and should no longer have a major role in AOM treatment. OME need not be treated with antibiotics unless the effusion has been present for 3 to 4 months. Tympanostomy tubes are an effective treatment for both chronic OME and recurrent AOM. Given the significant increase of DRSP during the past decade, clinicians must minimize antibiotic use and, when antibiotics are required, make judicious clinical decisions.