Appropriate treatment of acute otitis media in the era of antibiotic resistance.

The outcome of treatment for acute otitis media (AOM) differs between various antibiotic drugs. Outcome depends upon the drugs' pharmacokinetics, but in the case of infectious diseases also on the susceptibility of the organism and the interaction between the drug and the organisms at the specific site of infection (pharmacodynamics). In the era of antibiotic resistance, it is thus important to understand the pharmacokinetics/pharmacodynamics of the various available drugs in the context of AOM and its main two pathogens, Streptococcus pneumoniae and non-typeable Haemophilus influenzae. In terms of clinical outcome, it is also important to realize that AOM is a self-limiting disease in most cases, so that response to treatment is always compared with the expected background response when not treated. A favourable clinical outcome (cure/improvement) at the end of the treatment period is expected for those in whom the pathogens are eradicated within 3-5 days, thus clinical failure rates are several fold lower in children with early eradication (within 3-5 days) compared with those in whom no early eradication takes place. Because of the higher spontaneous bacterial elimination this might not always be appreciated. In this review, the relationship between antibiotic resistance, the various antibiotic drugs and their pharmacokinetic/pharmacodynamic patterns, the bacteriological outcome and clinical outcomes are addressed. This review is meant to assist the clinician in both a better understanding of the current recommendations for the treatment of AOM and the steps to be taken to follow AOM patients.