Which are the most common pathogens causing pediatric acute otitis media?

• A. Streptococcus pneumoniae
• B. Non-typeable Haemophilus influenzae
• C. Moraxella catarrhalis
• D. All of the above

Answer: (D)

Three bacteria are most commonly responsible for pediatric acute otitis media: Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis. Together they account for the majority of cases because they are common colonizers of the nasopharynx in children and can invade the middle ear when the Eustachian tube becomes dysfunctional or inflamed. S. pneumoniae has long been a leading cause, while non-typeable H. influenzae and Moraxella catarrhalis are also frequent culprits, and their presence shapes antibiotic choices since many strains produce beta-lactamase. Vaccination and regional factors can shift the exact proportions, but all three remain common players in pediatric AOM, making the all-of-the-above option the best answer.