The main bacterial causes of AOM are S. pneumoniae, non-typeable H. influenzae, and Moraxella catarrhalis. Since the introduction in SA of PCV-7 in 2009, followed by PCV-13 in 2011, the relative frequency of these three major middle ear pathogens has changed. H. influenzae has replaced S. pneumoniae as the most frequently isolated middle ear pathogen. Up to 12% (range 9.5 – 15%) of H. influenzae isolated from respiratory tract infections in SA produce β-lactamase, and this is even more frequent if the child was recently on antibiotics, resulting in resistance to penicillin.

The main bacterial causes of AOM are S. pneumoniae, non-typeable H. influenzae and Moraxella catarrhalis.

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