Ear infection superbug discovered to be resistant to all pediatric antibiotics

“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, M.D., professor of Microbiology, Immunology and Pediatrics at the University of Rochester Medical Center, and a partner at Legacy Pediatrics, 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, an author of the JAMA article.

Using an antibiotic not approved by the U.S. Food and Drug Administration (FDA) in children is a concern because the FDA makes certain that the drug is safe and effective before granting approval, Pichichero said.

The ‘off-label’ use of drugs like levofloxacin, a fluoroquinolone antibiotic, has been an area of intense debate because of potential safety issues, and because its excessive use in children, if it came about, may create resistance to the only drug effective against the superbug.

In the age of daycare, 83 percent of U.S. children experience one or more ear infections by age three. Acute otitis media is a bacterial ear infection that causes pain, fluid buildup and hearing loss in the worst cases. Until 2000, one species of bacteria, S. pneumoniae, also called pneumoccous, was the leading cause of otitis media, as well as of pneumonia and meningitis. Thanks to technology developed in part at the University of Rochester Medical Center, Wyeth Pharmaceuticals in 2000 introduced Prevnar (pneumococcal 7-valent conjugate vaccine), which reduced the incidence of pneumonia and meningitis by at least 69 percent, and difficult to treat ear infections by 24 percent as well, researchers said.

While tetanus is caused by a single strain of bacteria, S pnemoniae seeks to evade the human immune system by coating itself in 90 variations of sugar capsule that mimic human cell coatings. Seven of these capsule variations, the most common in children and adults, were included in the 2000 version of Prevnar to create immunity against them. The 19A strain is named after its sugar capsule type, which is not among the seven in Prevnar. With the most common seven strains knocked down by Prevnar, the next several most common, including 19A, “filled the vacuum.” Physicians in the US then “barraged kids with antibiotics, often unnecessarily,” Pichichero said. That created evolutionary pressure in favor of the bacteria most able to resist antibiotics.