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Prevention of acute mastoiditis: fact or fiction?
T E Linder1, H R Briner, T Bischoff
1Head and Neck Surgery, Department of Otorhinolaryngology, University Hospital of Zurich, Frauenklinikstr. 24, CH-8091, Zurich, Switzerland. linder@orl.usz.ch
Abstract:
Acute mastoiditis is the most common complication of acute otitis media (AOM). In recent years routine antibiotic treatment for acute middle ear infections was questioned and even abandoned in some countries. The goal of our study was to investigate the influence of antibiotic treatment on the occurrence and clinical outcome of acute mastoiditis and to analyze the bacteriological findings. A retrospective case record study of 48 patients with 50 episodes of acute mastoiditis hospitalized at our tertiary-care center between 1992 and 1999 was performed. Twenty-three patients (48%) received antibiotic treatment before admission whereas 25 (52%) did not. The group of patients without antibiotic pretreatment were younger (mean, 6 years) than patients with antibiotics (mean, 18 years) and their referral was delayed. The most common isolated single pathogen was Streptococcus pneumoniae. All pneumococci were sensitive to penicillin. Acute mastoiditis may be the first clinical sign of a middle ear infection, especially in very young children. Adequate antibiotic pretreatment cannot invariably prevent the development of acute mastoiditis even in the absence of penicillin resistant pathogens.
Insights
Antibiotic treatment does not always prevent acute mastoiditis, a complication of acute otitis media (AOM). Even sensitive bacteria like Streptococcus pneumoniae were found in patients with this condition.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Pediatrics
Background:
- Acute mastoiditis is a common complication of acute otitis media (AOM).
- Antibiotic use for AOM is increasingly debated.
- The impact of antibiotic pretreatment on acute mastoiditis is not well understood.
Purpose of the Study:
- To examine how antibiotic treatment affects acute mastoiditis occurrence and outcomes.
- To analyze the bacteriology of acute mastoiditis cases.
- To assess the role of antibiotic pretreatment in preventing acute mastoiditis.
Main Methods:
- Retrospective case record study.
- Involved 48 patients (50 episodes) hospitalized between 1992 and 1999.
- Compared outcomes for patients with and without prior antibiotic treatment.
Main Results:
- Nearly half of patients received antibiotics before admission.
- Younger patients (mean 6 years) were more common in the non-antibiotic group, with delayed referral.
- Streptococcus pneumoniae was the most frequent pathogen, and all isolates were penicillin-sensitive.
Conclusions:
- Acute mastoiditis can be the initial sign of AOM, particularly in young children.
- Antibiotic pretreatment does not consistently prevent acute mastoiditis.
- Penicillin-sensitive pathogens do not preclude the development of acute mastoiditis.