Bacteriological features and chemotherapy of adult acute purulent otitis media.

Eighty-eight patients from 16 to 79 years old, with acute purulent otitis media, were bacteriologically examined at the Otorhinolaryngology Department of a primary care hospital in Tokyo from July 1979 to May 1983. Fifty-six patients underwent paracentesis, and 32 patients exhibited otorrhea due to previous spontaneous perforation of the tympanic membrane. Bacteriologic cultures revealed the presence of Streptococcus pneumoniae (62.5 per cent), including S. pneumoniae Type III (28.1 per cent), Haemophilus influenzae (10.5 per cent), Staphylococcus aureus (11.5 per cent), and Streptococcus pyogenes (7.3 per cent). S. pneumoniae Type III had a notably high detection rate in patients from 50 to 79 years old (50-75 per cent). Because Haemophilus influenzae was detected at a relatively high rate in patients of all ages, if can be considered as a major causative pathogen of AOM. In 44 patients, selected mainly from those who underwent paracentesis, a comparative study of bacteria found in middle ear fluid and naso-pharyngeal mucus revealed the same bacteria in 43 out of 44 cases (97.7 per cent), indicating the presence of bacterial infection through the auditory canal. Antibiotics were selected according to an Expected Efficacy Index (EEI), the antibiotic of first choice being Ampicillin or Cefaclor.