RESUMEN
This study was performed on 317 patients attended to pediatric and ENT- Outpatient Clinics at Al-Azhar University Hospital of Assiut during 2 years from 2009-2011, samples were collected from middle ear fluid, 161 patients were males and 156 were females, patients were of different ages ranges from 6 months to 75 years old, children under 10 years represented 53.3% [169] of total patients in this study. The objectives were to determine the macrolide resistance of isolated Strept. pneumoniae. Out of the 317 cases of otitis media, 78 isolates of Strept. pneumoniae were obtained [24.6%]. Out of them 66 isolates were from 196 cases of acute otitis media [33.7%] and 12 isolates were from 121 cases of chronic otitis media [9.9%]. There were 45 isolates from males, while 33 were from females. Most isolates were taken from patients under 10 years old [51 isolates]. Sensitivity pattern of Streptococcus pneumonia showed that 30.7%, 26.9% and 24.4% were resistant to erythromycin, clarithromycin and azithromycin respectively. As previous findings proved that pneumnococci resistant to erythromycin have mainly one or both distinct resistance determinants either erm[B] or mef[E]. PCR was done to detect these genes in isolates [24] erythromycin resistance, it was observed that 33.3% harbored mef genes, 8.3% erm genes and 41.6% both mef and erm genes. erm B and mef E genes were detected using agarose gel electrophoresis at 224 and 347 bp respectively