[Effect of antibiotics on the occurrence and course of acute mastoiditis]

Acute mastoiditis is the most common complication of acute otitis media. In the last years routine antibiotic treatment of acute otitis media 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 analyse the bacteriological findings. In a retrospective chart review we identified all patients with the diagnosis of acute mastoiditis who had been referred to our tertiary-care centre between 1992 and 1999. We identified 48 patients with 50 episodes. 23 patients (48%) had received antibiotic treatment before admission whereas 25 (52%) had not. The patients with antibiotic pretreatment were older (18 years) than patients without antibiotics (6 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 can not always prevent the development of acute mastoiditis even in the absence of penicillin resistant pathogens.