The incidence of M parallels that of AOM, peaking in those aged 6 to 13 months. The incidence of M has decreased since the advent of antimicrobial agents and has become quite rare. The incidence of M from AOM in the U.S.A., and other developed countries is currently 0.004% (1-3). However, developing countries have a higher incidence of M, mostly as a consequence of untreated otitis media. Although the incidence of the disease has significantly declined in the U.S.A., it is still a significant infection with the potential of life-threatening complications. Of great concern is the sharp increase noted in the last decade in the incidence of acute M in several locations (2). This increase may be due to the greater recovery rate of resistant organisms, increased virulence of the pathogens and a lower use of antibiotics for the therapy of AOM (3).

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