Vol. 93 No.6 May　2000

The Current Status of Infectious Diseases in Otorhinolaryngology with Special Emphasis on Acute Otitis Media and Treatment Strategy for Antimicrobial Resistant Pathogens

 Noboru Yamanaka and Muneki Hotomi (Wakayama Medical College)

         He status of infectious diseases in otorhinolaryngology has changed in recent years.  Acute otitis media is a common infectious disease among children.  Recently, clinical features of the illness have changed by several factors including an increase of antimicrobial-resistant pathogens, altered life style, and derangement of immune responses of the host.  Penicillin-resistant Streptococcus pneumoniae were identified in about 30 % of nasopharyngeal cultures from children with AOM.  The isolated strains also had ermAM and mefE genes that were associated with resistance to macrolides.  A study of the changes of S.pneumoniae in the nasopharynx by pulsed-field gel electrophoresis (PFGE) showed that the second episode was caused by the reinfection with a different strain rather than by persistence and reemergence of the first strain.  Analysis of strains from siblings with AOM by PFGE also suggested that person-to-person transmission of the pathogen can occur among children.  A study of the immune responses to S.pneumoniae in otitis-prone children showed that about 54 % of the patients had subnormal levels of anti-pneumococcal capsular polysaccharide-specific IgG2.  
          These factors will be closely associated with the variation of the clinical features of AOM.  We should pay much attention to the risks of selecting drug-resistant pathogens by empiric treatment.  We should manage AOM with not only antibiotics but also otorhilonaryngological procedures like myringotomy, and washings of the nasopharynx and sinus to eliminate pathogens.

Key words: acute otitis media, treatment, immune response, penicillin-resistant S.pneumoniae, pulsed-field gel electrophoresis