Suppurative complications of acute otitis media in the era of antibiotic resistance

Objective: To review our experience with suppurative complications of acute otitis media (AOM) in the era of antibiotic resistance, given a perceived increase in the number of such cases in recent years requiring surgical intervention. Design: Retrospective review of pediatric patients presenting with suppurative complications of AOM from January 1993 to June 2000. Setting: Academic tertiary care children's medical center. Patients: A total of 90 pediatric patients, ranging in age from 3 months to 16 years (mean age, 45 months). Results: A total of 104 suppurative complications of AOM occurred in 90 patients over the 7.5-year study period. The incidence of noncoalescent, coalescent, and total cases of mastoiditis and total number of suppurative complications all increased over the study period, with coalescent outpacing noncoalescent disease during the last 3 years of the study. A trend toward an increasing number of cases requiring surgical intervention was noted during the study period, corresponding to an increasing number of resistant Streptococcus pneumoniae isolates. Ten of 16 S pneumoniae isolates were resistant, primarily collected from younger children ranging in age from 4 to 24 months (mean age, 11.9 months). Conclusion: The rising incidence of resistant S pneumoniae corresponded to the increasing number of suppurative complications of AOM during the study period and seemed to contribute to more aggressive infectious processes requiring surgical intervention.