Bacteriological study of acute purulent otitis media in adults.

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The bacterial contents in the middle ears of patients with acute purulent otitis media aged 16 to 79 years was studied, and guideline for the selection of antibiotics for its treatment was proposed.1) Chief bacteria were Streptococcus pneumoniae (62.5%), Haemophilus inffuenzae (10.5%), Staphylococcus aureus (11.5%), and Streptococcus pyogenes (7.3%).2) Type III S. pneumoniae, which accounted for 28.1% of all the isolated strains, is major cause of adult otitis media.3) H. influenzae, found in all age brackets, is major cause of adult as well as childhood otitis media.4) Comparison of bacteria from middle ear effusion and nasopharyngeal mucosa revealed the same species of bacteria at both sites in 43 of the 44 patients (97.7%). The Eustachian tube is the primary channel of infection even in adults.5) For a guideline to the selection of proper antibiotics, the expected efficacy index (EEI) was calculated from the results of an antibiotic susceptibility test by the standardized single disk method and from the ratios of major bacteria. EEI decrease in the order: ampicillin<clindamycin<erythromycin<tetracyclin <cephalexin. ABPC, therefore, is the first choice. For patients allergic to penicillin, CLDM should be used.
耳鼻咽喉科臨床学会の論文