WebMD Medical News
Louise Chang, MD
Sept. 17, 2007 (Chicago) -- Since the 2000 introduction of the pneumococcal
vaccine to prevent ear infections in children, a superbug that is
resistant to all the antibiotics approved to treat the condition has emerged,
Children who carry the superbug develop particularly agonizing middle ear
infections and often need surgical insertion of pressure-equalizing tubes in
the ears, says Michael Pichichero, MD, a pediatrician and vaccine researcher at
the University of Rochester in Rochester, N.Y.
Pneumococcal bacteria cause 30% to 55% of kids' ear infections. More than
four out of five kids get at least one ear infection by the age of 3. It's the
most common reason doctors give antibiotic drugs to children.
In 2000, a pneumococcal vaccine became commercially available for children
under age 2. Sold as Prevnar, the pneumococcal
vaccine attacks seven strains of the bacterium Streptococcuspneumoniae that can cause
In the early years following its introduction, the pneumococcal vaccine cut
middle ear infections by 20%, Pichichero says.
But by 2003, problems began to emerge, he tells WebMD. That’s when doctors
began to see kids with ear infections caused by strains of S. pneumoniae
other than the seven included in the vaccine.
The new study was presented here at a meeting of the American Society for
(How do you feel about using antibiotics for ear infections? Talk about
it on WebMD's Parenting: 9-12 Months message board.)
The study included 162 children with recurrent ear infections. All of the
children had received the pneumococcal vaccine.
All the children underwent ear taps, a procedure during which doctors put a
needle into the eardrum to draw out infected fluid so they can examine the
They found that 59 children carried the S. pneumoniae bacterium.
Of these, nine children carried a new strain called 19A that is not included
in the vaccine and proved resistant to all FDA-approved antibiotics for ear
infections in children.
"Children infected with this strain were unsuccessfully treated with two or
more antibiotics," Pichichero says.
Keith Klugman, MD, an infectious disease specialist at Emory University in
Atlanta and moderator of the session at which Pichichero’s study was presented,
says that researchers now know of 91 different strains of S.
The 19A strain is particularly troubling, he says.
"The vaccine took away all of the competing strains, so there’s more of this
virulent 19A strain in the body," Klugman tells WebMD.
Klugman notes that Wyeth pharmaceutical company is developing a vaccine that
includes strain 19A.
"That should help resolve the problem," he says.
Pichichero tells WebMD that children with recurring ear infections should
undergo an ear tap, called tympanocentesis, as that’s the only way to determine
if someone has a resistant strain of the bacteria.
He adds that he’s not convinced the vaccine is totally to blame for the
emergence of the drug-resistant ear infection. "It could have happened in
SOURCES: 47th Interscience Conference on Antimicrobial Agents and
Chemotherapy, Chicago, Sept. 17-20, 2007. Michael Pichichero, MD, University of
Rochester, Rochester, N.Y. Keith Klugman, MD, Emory University, Atlanta.
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