***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the bacteriologic efficacy of ceftriaxone in nonresponsive acute otitis media in children . METHODS In a prospect i ve study 92 patients ages 3 to 36 months ( median , 11 months ) with culture-proved nonresponsive acute otitis media were studied from January , 1995 , through August , 1997 . The patients were treated with intramuscular ceftriaxone ( 50 mg/kg/l/day ) for 3 days . Middle ear fluid was aspirated for culture by tympanocentesis on day of enrollment ( Day 1 ) ; a second tap was performed on Days 4 to 10 . Additional middle ear fluid cultures were obtained if clinical relapse occurred . Bacteriologic failure was defined by positive culture on Days 4 to 10 . Patients were followed until Day 17+/-2 . Susceptibility was measured by E test . RESULTS The main drugs administered before enrollment were amoxicillin ( 38 % ) , amoxicillinclavulanate ( 25 % ) and cefaclor ( 20 % ) . Organisms recovered ( n=105 ) were : Haemophilus influenzae , 54 ; Streptococcus pneumoniae , 47 ; Moraxella catarrhalis , 2 ; and Streptococcus pyogenes , 2 . Thirty-four ( 72 % ) of the 47 S. pneumoniae isolates were intermediately resistant to penicillin ( MIC 0.1 to 1.0 microg/ml ) , but all were susceptible to ceftriaxone ( MIC < 0.5 microg/ml ) . Bacteriologic eradication was achieved in 100 of 105 ( 95 % ) cases : 54 of 54 ( 10O% ) H. influenzae , 43 of 47 ( 92 % ) S. pneumoniae , 1 of 2 ( 50 % ) M. catarrhalis and 2 of 2 ( 100 % ) S. pyogenes . Bacteriologic success ( with no relapse ) occurred in 13 of 13 ( 100 % ) penicillin-susceptible S. pneumoniae vs. 28 of 34 ( 82 % ) S. pneumoniae intermediately resistant to penicillin ( 4 cases of bacteriologic failure and 2 cases of relapse ) . CONCLUSION A 3-day intramuscular ceftriaxone regimen is efficacious for the treatment of nonresponsive acute otitis media . The optimal duration of treatment in cases of nonresponsive acute otitis media and whether ceftriaxone is efficacious for the treatment of nonresponsive otitis media caused by S. pneumoniae highly resistant to penicillin is yet to be determined Background The immunogenicity , reactogenicity , and safety of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine ( PHiD-CV ) co-administered with routine childhood vaccines were evaluated among infants from Singapore and Malaysia , where PHiD-CV has been licensed . Methods In the primary vaccination phase , 298 infants from Singapore and 168 infants from Malaysia were r and omised to receive the Phase III Clinical ( Clin ) or the Commercial ( Com ) lot of PHiD-CV  at 2 , 3 , and 5 months of age . In the booster vaccination phase , 238 toddlers from Singapore received one dose of the PHiD-CV Commercial lot at 18–21 months of age . Immune responses to pneumococcal polysaccharides were measured using 22F-inhibition enzyme-linked immunosorbent assay ( ELISA ) and functional opsonophagocytic activity ( OPA ) assay and to protein D , using ELISA . Results Immune responses induced by primary vaccination with the PHiD-CV Commercial lot were non-inferior to the Phase III Clinical lot in terms of adjusted antibody geometric mean concentration ( GMC ) ratios for each vaccine pneumococcal serotype and protein D. For each vaccine pneumococcal serotype , ≥93.6 % and ≥88.5 % of infants from Malaysia and Singapore had post- primary vaccination antibody concentrations ≥0.2 μg/mL and OPA titres ≥8 , in the Clin and Com groups , respectively . For each vaccine pneumococcal serotype , ≥60.8 % and ≥98.2 % of toddlers from Singapore had pre- and post-booster antibody concentrations ≥0.2 μg/mL , in the Clin and Com groups , respectively . All children , except one , had measurable anti-protein D antibodies and the primary and booster doses of the co-administered vaccines were immunogenic . The incidence of each grade 3 solicited symptom was ≤11.1 % in both study phases . No serious adverse events considered causally related to vaccination were reported throughout the study . Conclusions PHiD-CV given as three-dose primary vaccination to infants in Singapore and Malaysia and booster vaccination to toddlers in Singapore was shown to be immunogenic with a clinical ly acceptable-safety profile . This study has been registered at http://www . clinical trials.govNCT00808444 and NCT01119625 Objective : To describe NP and AOM otopathogens during the time frame 2007 to 2009 , 6 to 8 years after the introduction of 7-valent pneumococcal conjugate ( PCV7 ) in the United States and to compare nasopharyngeal ( NP ) colonization and acute otitis media ( AOM ) microbiology in children 6 to 36 months of age having first and second AOM episodes with children who are otitis prone . Methods : Prospect ively , the microbiology of NP colonization and AOM episodes was determined in 120 children with absent or infrequent AOM episodes . NP sample s were collected at 7 routine visits between 6 and 30 months of age and at the time of AOM . For first and subsequent AOM episodes , middle ear fluid ( MEF ) was obtained by tympanocentesis . Eighty otitis prone children were comparatively studied . All 200 children received age-appropriate doses of PCV7 . Results : We found PCV7 serotypes were virtually absent : ( 0.9 % isolated from both NP and MEF ) in both study groups . However , non-PCV7 serotypes replaced PCV serotypes such that the frequency of isolation of S. pneumoniae ( Spn ) was nearly equal to that of non-typeable Haemophilus influenzae ( NTHi ) . M. catarrhalis ( Mcat ) was less common and Staphylococcus aureus infrequent in the NP and MEF from the 2 groups . The proportion of Spn , NTHi and Mcat causing AOM was similar in children with first and second AOM episodes compared to otitis prone children . However , oxacillin-resistant Spn isolated from the NP and MEF was 19 % for the absent/infrequent and 58 % for the otitis prone groups , P < 0.0001 . Beta-lactamase producing NTHi occurred more frequently in the otitis prone group , P = 0.04 . Conclusions : Six to 8 years after widespread use of PCV7 , Spn strains expressing vaccine-type serotypes have virtually disappeared from the NP and MEF of vaccinated children . NP colonization and AOM has changed to non-PCV7 strains of Spn . NTHi continues to be a major AOM pathogen . The otopathogens in first and second AOM and in otitis prone children are very similar although Spn and NTHi are more often antibiotic resistant in the otitis prone Background Acute Otitis Media ( AOM ) is an important and common disease of childhood . Bacteria isolated from cases of clinical ly problematic AOM in German children were identified and characterized . Methods In a prospect i ve non-interventional study in German children between 3 months and less than 60 months of age with Ear , Nose and Throat Specialist –confirmed AOM , middle ear fluid was obtained by  tympanocentesis  ( when clinical ly indicated ) or by careful sampling of otorrhea through/at an existing perforation . Results In 100 children with severe AOM , Haemophilus influenzae was identified in 21 % ( 18/21 , 85.7 % were non-typeable [ NTHi ] ) , Streptococcus pneumoniae in 10 % , S. pyogenes in 13 % and Moraxella catarrhalis in 1 % . H. influenzae was the most frequently identified pathogen in children from 12 months of age . H. influenzae and S. pneumoniae were equally prevalent in children aged 3–11 months , but S. pyogenes was most frequently isolated in this age group . NTHi AOM disease appeared prevalent in all ages . Conclusions NTHi , S. pneumoniae and S. pyogenes are implicated as important causes of complicated AOM in children in Germany .  NTHi disease appears prevalent in all ages . The impact of vaccination to prevent NTHi and S. pneumoniae AOM may be substantial in this population and is worth investigating The safety and immunogenicity of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine ( PHiD-CV , Synflorix ™ ) were assessed in 240 healthy Chilean children r and omized to receive 3 doses of PHiD-CV ( PHiD-CV group ) or hepatitis A vaccine ( HAV control group ) at 2 - 4 - 6 months of age . All were offered 1 HAV dose at 12 months ( outside study ) . The PHiD-CV group received a second HAV dose at 18 - 21 months and PHiD-CV booster at 20 - 23 months . The HAV control group received 2 PHiD-CV catch-up doses at 18 - 21 and 20 - 23 months . Adverse events were recorded and pneumococcal antibody responses and opsonophagocytic activity ( OPA ) were measured . Both PHiD-CV vaccination schedules were well tolerated and immunogenic against the pneumococcal vaccine serotypes and protein D. The reactogenicity of PHiD-CV primary , booster and catch-up doses was in line with previous PHiD-CV studies , although generally higher than with HAV . For each vaccine serotype , the percentage of subjects with antibody concentrations ≥0.2 µg/ml ( GSK 's 22F-inhibition ELISA ) was at least 93.2 % following 3 PHiD-CV primary doses and at least 97.4 % post-booster ; percentages with OPA titers ≥8 were at least 91.7 % post-booster . After 2-dose catch-up , at least 94.3 % of children had antibody concentrations ≥0.2 µg/ml against each serotype except 6B ( 84.3 % ) ; at least 95.2 % had OPA titers ≥8 except against serotypes 1 , 5 and 6B . In conclusion , the safety profiles of 2 PHiD-CV vaccination schedules ( 3-dose primary plus booster and 2-dose catch-up ) were in line with previous studies and PHiD-CV was immunogenic for all 10 vaccine serotypes and protein BACKGROUND Clinical symptoms and signs in  acute otitis media ( AOM )  may differ depending on the various pneumococcal serotypes causing the disease . Alteration in clinical presentation of AOM could be expected after wide-scale pneumococcal vaccinations if there were considerable differences between vaccine serotypes and nonvaccine serotypes . METHODS In this study , data from 831 children in the control arm of the Finnish Otitis Media Vaccine Trial were used . The children were followed up prospect ively in 8 study clinics from 2 to 24 months of age . If AOM was diagnosed , myringotomy was done , and middle ear fluid was aspirated for bacterial culture . Clinical symptoms and signs of AOM were routinely recorded on structured case report forms . RESULTS Consistent with previous studies , 60 % of pneumococcal episodes were caused by vaccine serotypes . There were no major differences between the clinical presentations of AOM due to different serotypes or serotype categories . However , earache was more often associated with AOM caused by vaccine and cross-reactive serotypes , compared with AOM caused by non-vaccine-related serotypes ( 42 % vs. 29 % ; odds ratio , 1.66 ; 95 % confidence interval , 1.02 - 2.70 ) . CONCLUSIONS Introduction of the currently available pneumococcal conjugate vaccine is unlikely to result in a remarkable alteration in the clinical presentation of pneumococcal AOM in infants BACKGROUND Because of the increasing number of resistant middle ear pathogens reported from different centers worldwide , an active surveillance of the microbiology and susceptibility pattern of middle ear pathogens is required for proper antimicrobial recommendations among different regions of the world . OBJECTIVE To study the microbiology and susceptibility pattern of middle ear pathogens obtained from Costa Rican children with acute otitis media . METHODS Between 1992 and 1997 a diagnostic tympanocentesis was performed in 398 Costa Rican patients with acute otitis media . Middle ear fluid was obtained for culture and minimal  inhibitory concentr 
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Molecular methods can also improve monitoring of regional changes in the serotypes and identification frequency of S. pneumoniae and H. influenzae over time or after vaccine implementation , such as after introduction of the 7-valent pneumococcal conjugate vaccine .
Globally , S. pneumoniae and H. influenzae remain the predominant otopathogens associated with OM as identified through bacterial culture ; however , molecular methods continue to improve the frequency and accuracy of detection of individual serotypes .