Pcv-7 Vaccine: Changing the Epidemiology of Acute Otitis Media*

Introduction of the 7-valent pneumococcal conjugate vaccine (PCV-7) has been associated with a modest reduction in the incidence of acute otitis media (AOM) and a shift in the etiology of AOM pathogens. In both rural and suburban settings in which use of PCV-7 has been widespread, there has been a decrease in AOM episodes caused by Streptococcus pneumonia, the predominant AOM pathogen in the pre–PCV7 era, and an increase in those caused by Haemophilus influenzae. Even in the decade prior to the introduction of PCV-7, tympanocentesis-based multicenter trials documented an increase in the incidence of AOM due to H influenzae, and PCV-7 appears to have accelerated this increase. The changing microbiology of AOM affects treatment choices. The American Academy of Pediatrics/American Association of Family Physicians-recommended first-line agent for most children with AOM, high-dose amoxicillin (80-90 mg/kg/day), may not be the agent of first choice in the real-world setting in which local resistance patterns and other important variables such as cost, adverse events profiles, and adherence issues determine antibiotic selection. For children who fail initial amoxicillin therapy, the increasing predominance of H influenzae warrants consideration of a wider array of treatment options than just high-dose amoxicillin/clavulanate. The excellent coverage of H influenzae as well as most penicillin-susceptible and penicillin-intermediate S pneumoniae provided by the cephalosporins cefdinir, cefuroxime, and cefpodoxime makes these agents reasonable treatment options for initial empiric therapy as well as amoxicillin treatment failures. (Adv Stud Med. 2004;4(10E):S928-S936)