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June 10, 1998

Controversies: Treatment of Acute Otitis Media

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(22):1783-1785. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-22-jac80008

To the Editor.— Before the antibiotic era, streptococci were one of the main lethal threats for humans. Up to 50% of all AOM attacks were caused by Streptococcus pyogenes. After the introduction of antibiotics, there was a shift from highly virulent gram-positive bacteria to less virulent gram-negative bacteria, and the incidence of mastoiditis declined rapidly.1 In developed countries, the bacterial spectrum of causative agents of AOM have remained mainly the same since the 1950s. In addition, through successful vaccination programs, the danger from Haemophilus influenzae type b infections in children has been almost eradicated.2 Despite these facts, the use of antibiotics, and especially broad-spectrum antibiotics, has increased tremendously. The threat has changed but not our strategy. We are facing severe problems with increasing bacterial resistance to antibiotics worldwide. We cannot expect a new penicillin-like miracle, but we can invest in new and more effective drugs and vaccines and develop more restrained prescription habits. Since AOM is the most frequent diagnosis for antibiotic use in outpatients, this is a good starting point to change routine habits, as pointed out by Drs Culpepper and Froom.3

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