Antimicrobial susceptibility of bacterial isolates from patients
presenting with ear, nose and throat (ENT) infections
in the German community healthcare setting
Working Party ‘Antimicrobial Resistance’ of the Paul-Ehrlich-Society for Chemotherapy
Received: 5 April 2017 /Accepted: 5 April 2017 /Published online: 20 April 2017
Springer-Verlag Berlin Heidelberg 2017
Abstract Empiric initial antibiotic therapy of bacterial infec-
tions is based primarily upon the susceptibility of the most
common causative pathogens. The purpose of this study was
to provide susceptibility data on six bacterial species known to
cause ear, nose and throat (ENT) infections. A total of 1066
isolates collected during a nationwide laboratory-based sur-
veillance study were analysed. All Streptococcus pyogenes
isolates were penicillin (PEN)-susceptible, indicating that nat-
ural penicillins can still be recommended as the first-line treat-
ment for group A streptococcal tonsillopharyngitis. Of the
S. pneumoniae isolates, 92.9% were PEN-susceptible and of
the Haemophilus influenzae isolates, 89.7% were amoxicillin-
susceptible, retaining aminopenicillins as the first-line treat-
ment for acute otitis media (AOM) and acute rhinosinusitis
(ARS), in case antibiotic therapy is considered. In contrast,
cefuroxime axetil seems less likely to be suitable for the treat-
ment of AOM or ARS, as all Moraxella catarrhalis and >99%
of the H. influenzae isolates were categorised as intermediate
or resistant. The susceptibility rates of Pseudomonas
aeruginosa were 97–100% for the drugs tested, except for
the fluoroquinolones (87.6%). Overall, bacterial isolates from
outpatients presenting with ENT infections showed low fre-
quencies of resistance in Germany. However, given the emer-
gence of multidrug resistance to standard antibiotics in
Escherichia coli and other pathogens, inappropriate use of
broad-spectrum antibiotics for the treatment of ENT infections
has to be avoided.
In Germany, about 85% of the antibiotics in human medicine
are prescribed in the outpatient setting. Infections of the ears,
the paranasal sinuses and the throat account for a relevant
proportion of these infections . The indications ‘acute ton-
sillitis’, ‘otitis media’ and ‘scarlet fever’ account for nearly
half of the antibiotic prescriptions in children under 16 years
old . Empiric initial antibiotic therapy of bacterial
Bernhard Olzowy and Michael Kresken contributed equally to the manuscript.
Members of the Working Party ‘Antimicrobial Resistance’ of the Paul-
Ehrlich-Society for Chemotherapy In addition to the authors, the following
members of the study group (in alphabetical order) contributed to the study:
L. Artz (Ingolstadt), T. Becker (Munich), B. Berger-Schreck (Cologne), S.
Burak (Düsseldorf), J. Cremer (Kempten), S. Cuenca (Augsburg), A.
Eberhard (Dortmund), U. Eigner (Heidelberg), J. Enzenauer (Osnabrück), J.
Esser (Osnabrück), I. Fenner (Hamburg), G. Funke (Ravensburg, now
Schaan, Switzerland), A. Gehrt (Düsseldorf), C. Haas (Freiburg), I.
Hamann (Görlitz), T. Hermann (Würzburg), R. Hillert (Görlitz), W.
Hönerlage (Hamburg), I. Hofmann (Leipzig), M. Holfelder (Heidelberg), F.
Hugo (Berlin), U. Knipp (Trier), S. Krämer (Essen), R. Krajewski
(Dortmund), A. Reinecke (Rostock), H. Sahly (Hamburg), S. Schmitt
(Kaiserslautern), M. Schröter (Jena), R. Schwarz (Mönchengladbach), A.
Siedlaczek (Freiburg), H. Wisplinghoff (Cologne) and B. Zöllner (Moers).
* M. Kresken
HNO-Zentrum Landsberg, Hubert-von-Herkomer-Straße 111,
86899 Landsberg, Germany
Antiinfectives Intelligence GmbH, Campus of the University of
Applied Sciences, Von-Liebig-Straße 20,
53359 Rheinbach, Germany
University of Applied Sciences gGmbH, Schaevenstraße 1 a-b,
50676 Cologne, Germany
Department of Otorhinolaryngology, Head and Neck Surgery,
University of Munich, Marchioninistraße 15,
81377 Munich, Germany
Institute of Pharmacology and Clinical Pharmacology,
Heinrich-Heine-University, Moorenstraße 5,
40225 Düsseldorf, Germany
Eur J Clin Microbiol Infect Dis (2017) 36:1685–1690