Past, present, and future: an overview of the microbiology of acute otitis media.

Helpful new treatment guidelines offer physicians structure in diagnosing and treating patients who have uncomplicated acute otitis media (AOM). These guidelines should be weighed in light of the evolving microbiology of AOM pathogens. Physicians must be cognizant of the cyclical changes in bacteria as well as new vaccines and antibiotics best suited to address AOM. Although pneumococcal vaccines have helped, serotype shifts and bacterial resistance could work against current treatment practices. Physicians should understand causal organisms and treat patients appropriately to mitigate antibiotic resistance. New vaccines in development may offer additional reduction in AOM and drug resistant pneumococcus in the future.