Right choice of antibiotic can decrease risk of recurrence

EDITOR—Roos et al showed that α haemolytic streptococci—a part of the normal flora—have a protective effect against otitis media.1 Even though the effect was modest, this finding is remarkable and should influence antibiotic policy.

Broad spectrum antibiotics impair the normal flora. In a recent epidemiological survey we found an association between the use of such antibiotics and an increased risk of recurrence of acute otitis media (broad spectrum antibiotics v phenoxymethylpenicillin: odds ratio 1.8 (95% confidence interval 1.3 to 2.6)).2 Howard et al showed that recurrences were less common among children treated with a narrow spectrum drug (penicillin or erythromycin) than among those treated with a broad spectrum antimicrobial (amoxicillin or erythromycin plus sulphonamide) (13.3% v 40.5%, P=0.0125).3

Nowadays, broad spectrum antibiotics are increasingly used to treat otitis, although the clinical picture of this disease has become milder.2 Broad spectrum drugs have not been shown to have therapeutic advantages over narrow spectrum drugs in uncomplicated acute otitis media,4 but abundant use of them has ecological drawbacks in selecting resistant bacteria.5 These facts support the idea that the first line …