Dr. Stephen I. Pelton commented that previous research has demonstrated that about 30% of children under 7 years of age harbor S. pneumoniae in their nasopharynx, and approximately 20% of S. pneumoniae are type 19A.
“The multidrug resistant [MDR] 19A is only a small fraction of the 19A isolates currently circulating in the community, and the risk for carriage of an MDR isolate is relatively low, involving about 1% or 2% of children,” explained Dr. Pelton, chief of pediatric infectious disease at Boston Medical Center.
The off-label use of levofloxacin may be necessary for children failing therapy.
“Documentation of the presence of MDR 19A in either pneumococcal pneumonia or middle ear disease probably is a good idea before initiating the use of levofloxacin,” Dr. Pelton added in an interview.
In fact, if MDR S. pneumoniae is suspected, then documentation by tympanocentesis or at a minimum nasopharyngeal culture is a good approach, he said.
After dropping for the first 3 years after the PCV vaccine, S. pneumoniae ear infections are now rising again. DR. PICHICHERO