Otorrhea bacterial profile, epidemiology before widespread use of the third-generation pneumococcal conjugate vaccine in French children, a prospective study from 2015 to 2023

Antibiotic Resistance of Haemophilus influenzae in Nasopharyngeal Carriage of Children with Acute Otitis Media and in Middle Ear Fluid from Otorrhea

“…Finally, the stability of Hi β-lactam resistance at a relatively moderate level (<15%) in nasopharyngeal carriage and MEF samples among children with AOM seems reassuring. From the current results, coupled with those recently published on pneumococcal and group A streptococcal AOM [9,21], it seems neither useful nor wise to change the French guidelines for first-line treatment of AOM in favor of more "critical" antibiotics. Indeed, although amoxicillin-clavulanate, the first critical antibiotic because of its digestive side effects and greater ecological impact, counteracts the production of β-lactamase, it does not fully restore the activity of amoxicillin on BLNAR Hi.…”

“…Notable changes have appeared in the last 20 years: the implementation of the 7-and 13-valent pneumococcal conjugate vaccines (PCVs), the decrease in the rate of antibiotic prescriptions, and the narrowed spectrum of antibiotics prescribed with a decreased use of third-generation cephalosporins and amoxicillin-clavulanate, which were replaced by amoxicillin [8]. Notably, the widespread utilization of PCVs led to a significant decrease in the prevalence of penicillin-non-susceptible pneumococci in the nasopharyngeal flora of children, a decreasing share of pneumococci, and, proportionally, an increasing role of Hi in pediatric AOM [9]. In addition, a recent study suggested an increase in Hi βlactamase-producing strains, [10], which might lead to reconsider first-line treatments for Hi-associated diseases.…”