The discovery of a strain of bacteria resistant to all approved drugs used to fight ear infections in children has been reported in the Journal of the American Medical Association. Two pediatricians discovered the strain because it is their standard practice to perform an uncommon procedure called tympanocentesis (ear tap) on children when several antibiotics fail to clear up their ear infections. The procedure involves puncturing the child's eardrum and draining fluid to relieve pressure and pain. Analyzing the drained fluid is the only way to establish the bacterial strain causing the infection.
Even after the ear tap and additional rounds of antibiotics, infections persisted in a small group of children in a Rochester, New York, pediatric practice, leading to ear tube surgery and, in one case, to permanent hearing loss. The physicians realized they may be dealing with a "superbug" and tested the children's ear tap fluid. The tests showed that the superbug, called the 19A strain, could be killed only by an antibiotic (levofloxacin, Levaquin) approved for adults that had a warning in its label against use in children. With no other choice, they treated the children with crushed, adult-approved pills, and it worked.
The 19A strain was most likely created by a combination of the speed of bacterial evolution and the overprescribing of antibiotics, the researchers said. They warn that, while it may very well never happen, the medical profession must now at least consider the prospect of a worse-case scenario: this multi-drug-resistant bacterial ear infection spreads to other communities, or invades the lungs and bloodstream, where it leads to cases of pneumonia or meningitis treatable only with unconventional antibiotics not approved for use in children.
"Children with the new strain of superbug represented a small subset of those in our practice, but the results are worrisome, especially since there are no new antibiotics in the pipeline for ear infections in children," said Michael Pichichero, a partner at the private practice involved. "While we must be careful not to create undue alarm, the potential exists for newly evolved strains to spread to the ears of more children," said Pichichero.
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Source: University of Rochester Medical Center
