Most Common Pathogens of Otitis Media in Pediatrics and Their Resistance to Antimicrobial Agents

Acute otitis media (AOM) stands as a prevalent child­hood illness, frequently necessitating antibiotic treatment. Its burden is significant, affecting about 80% of children under 3 years old, with approximately 40% experiencing recurrent episodes by age 3. In a study spanning Euro­pean countries, including Lithuania, middle ear otitis occurred at a rate of 160.7 cases per 100,000 children per year. Post-pneumococcal conjugate vaccine (PCV) implementation, causative agents shifted towards non-vaccine pneumococcal types and Haemophilus influen­zae. Antibiotic prescription rates, as noted from surveys of European pediatricians, range up to 78% for otitis media with effusion (OME). Commonly prescribed me­dications include amoxicillin (88.5%), amoxicillin-cla­vulanate (7.8%), cephalosporins (3.4%), and macrolides (0.3%). Despite similar antibiotic prescription frequen­cies in Eastern Europe and the Baltic, prescription practi­ces differ, influenced by active otitis monitoring. In this review article, we care to provide up to date cri­tical review of the literature on AOM prevalence, most common pathogens and antimicrobial resistance. Conclusions and recommendations. The most common pathogens of acute otitis media are Streptococcus pneu­moniae and Haemophilus influenzae, with S. pneumoniae often showing resistance to penicillin and erythromycin, while H. influenzae tends to be resistant primarily to ampicillin and amoxicillin when combined with clavu­lanic acid; however, due to increased PCV vaccination, H. influenzae is becoming more prevalent, especially among patients unresponsive to first-line treatment with amoxicillin, often due to β-lactamase-producing strains.