Systematic Review of Antibiotic Resistance in Bacteria Causing Otitis Media in Iraq (2014–2025)

Otitis media is one of the most common infections, especially in children. Despite numerous studies conducted across Iraq, no unified comparative analysis has consolidated their findings. This systematic review analyzes 34 Iraqi studies published between 2014 and 2025 to identify prevalent bacterial pathogens and antibiotic resistance patterns in otitis media. Data from peer-reviewed articles, theses, and reports were extracted, covering patient demographics, isolated bacteria, and antibiotic susceptibility. Streptococcus pneumoniae and Haemophiles influenzae were frequently isolated in acute cases, while Pseudomonas aeruginosa and Staphylococcus aureus dominated in chronic or resistant cases. A notable increase in resistance, particularly to penicillin’s and trimethoprim, was observed. Conversely, ciprofloxacin and ceftriaxone remained more effective. Males and younger age groups were more affected. The findings underscore rising antimicrobial resistance and the necessity for region-specific treatment strategies. The review advocates for bacterial culture and sensitivity testing before empirical treatment and supports national policies promoting responsible antibiotic use in Iraq.