Acute otitis media in ambulatory practice: Epidemiological and clinical characteristics after 7 valent pneumococcal conjugate vaccine (PCV7) implementation

Background. - In US, pneumococcal conjugate vaccine (PCV7) had reduced the burden of AOM and changed the profile of the disease. Prior to PCV7 implementation in France, AOM represented 8% of pediatricians visits and failure rate was 12%. The aim of this study is to describe the epidemiologic characteristics of AOM after PCV7 implementation. Methods. - From 2007 to 2008, 30 pediatricians enrolled 3141 patients 3 to 36 months old with AOM. Standardized history and physical examination findings were recorded. Factors related to AOM failures were identified by multivariate logistic regression. Results. - AOM accounted for 5.8% of the 43 433 visits or 6.2 cases/week per pediatrician. Among 3141 evaluable AOM cases (mean age 16.7 +/- 8 months, peak incidence at 10 months), 99% had been vaccinated with PCV7 and 42.1% attended day care (DCC). Recurrent AOM comprised 24.5% of cases and 51% of children had received ATB in the last 3 months. At the time of diagnosis, 47.1% had fever >= 38,5 degrees C, 74.5% otalgia and 4.7% otorrhea. Febrile and painful AOM accounted for 29.5% of cases and cunjunctivitis-otitis syndrome for I 8.2%. ATB was prescribed in 98.7% of cases (cefpodoxime proxetil, 59% and amoxicillin/clavulanate, 37%). The failure rate was 6.4% and failure risk was greater in children in DCC (OR = 1.50, [1.10;2.05]), young age < 18 months (OR = 1.47, [1.06;2.04]) and history of recurrent AOM (OR = 1.45, [1.02;2.06]). Conclusion. - Despite PCV7 implementation, AOM remains a very frequent childhood infection and a major reason for ATB prescriptions. (C) 2011 Elsevier Masson SAS. All rights reserved.