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The Changing Treatment Paradigm for Acute Otitis Media—Reply

Michael E. Pichichero, MD
JAMA. 1998;280(22):1903-1904. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-22-jac80017.
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In Reply.—In the 1997 Red Book, the American Academy of Pediatrics Committee on Infectious Diseases recommends that for AOM "patients who fail standard therapy and are suspected to have penicillin resistant Streptococcus pneumoniaeinfections . . . myringotomy should be considered."1 The Centers for Disease Control and Prevention's Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group recommends that, "in cases of clinically-defined treatment failure, consideration should be given to identification of the etiologic agent by tympanocentesis for susceptibility testing to guide alternative antibiotic therapy" (unpublished report, 1998). Berman2 advocates the use of tympanocentesis to determine antibiotic therapy in unresponsive AOM. Giebink et al3 note that viral infection may be a significant factor in antibiotic treatment failure and underscore the value of tympanocentesis. Klein4 states that the ill-appearing child may benefit from tympanocentesis for identification of bacterial pathogens and study of antimicrobial susceptibility. Stool5 described myringotomy as an office procedure and recommended it for children with AOM with severe pain, for children with AOM or chronic otitis media who fail to respond to antibiotic therapy, and for children with recurrent episodes of AOM at short intervals.5 Tympanocentesis can identify the 30% of patients with AOM and the 50% of patients with persistent and recurrent AOM who require no antibiotic therapy because no viable bacterial pathogen is present,6 thereby allowing curtailment of unnecessary antibiotic treatment.

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