Clinical implications of antibiotic resistance for management of acute otitis media

The development of resistance by Streptococcus pneumoniae and Haemophilus influenzae to antimicrobial agents used for the management of AOM has raised concerns about their continued efficacy. The development of resistance has been evident from the first experiences with chemotherapy. Sulfonamides were initially effective against group A streptococci and pneumococci, but within 10 years after introduction, these streptococcal species had developed modes of resistance. Each decade brought new challenges in the form of the development of resistance of important bacterial pathogens: the pandemic of multi-drug-resistant Staphylococcus aureus in the 1950s; outbreaks of resistant gram-negative enteric bacilli in the 1960s; the new phenomena of beta-lactamase-producing H. influenzae and Moraxella catarrhalis in the 1970s; and the worldwide spread of multi-drug-resistant pneumococci beginning in the 1980s and continuing to the present. Thus the experience of the antibiotic era indicates that the development of resistance to available antimicrobial agents is to be expected.