Summary: Acute otitis media (AOM) is one of the most common childhood diseases in pediatric and family medicine practice and its complications requiring surgical intervention are an important part of Ear Nose Throat surgeons’ activity. In the majority of cases it is initiated with upper respiratory viral infections, viruses initiate an inflammatory process in the eustachian tube, which affects the middle ear cavity. Thus, initially it is a viral infection and subsequently it is superimposed with bacterial pathogens, which colonize the nasopharyngeal cavity and are aspirated to the middle ear cavity. Streptococcus pneumoniae (SP) dominate as the leading pathogen of AOM, but in the case of recurrence and in a population sufficiently vaccinated against SP, the nontypeable Haemophilus influenzae (NtHi) become the leading pathogens. The 24-72 h delay of antibiotic application, a “watchful waiting strategy” and intensive analgesic and anti-inflammatory therapy is strongly recommended in AOM therapy. Amoxicillin in a relatively high dose is still the basic initial recommended antibiotic therapy for Polish children, who are generally vaccinated against SP since recently, but soon it can appear that NtHi is the leading pathogen and amoxicillin/clavulanic acid should be the initial basic therapy.
Vaccination against SP is a very important factor determining the antibiotic strategy in AOM therapy.