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The relationship between acute mastoiditis and antibiotic use for acute otitis media in children
David Ho1, Brian W Rotenberg, Robert G Berkowitz
1Department of Otolaryngology, Royal Children's Hospital, Victoria 3052, Australia.
Insights
Prior antibiotic use in children with acute otitis media did not significantly impact the development of acute mastoiditis. This suggests antibiotics may not prevent mastoiditis progression.
Area of Science:
- Pediatric infectious diseases
- Otolaryngology
- Microbiology
Background:
- Acute mastoiditis (AM) is a serious complication of acute otitis media.
- The role of prior antibiotic exposure in AM development is not fully understood.
Purpose of the Study:
- To investigate the association between prior antibiotic use and the incidence of acute mastoiditis in children.
Main Methods:
- Retrospective review of 129 pediatric patients diagnosed with AM between 1996 and 2005.
- Analysis of prehospitalization antibiotic treatment records.
- Comparison of antibiotic use in patients with and without subperiosteal abscess.
Main Results:
- Over half of AM patients (51.9%) received prior antimicrobial treatment.
- The percentage of AM patients with prior antibiotic use for acute otitis media (AOM) decreased from 64% in 1996 to 27% in 2005.
- No significant difference in prior antibiotic use was observed between patients with and without subperiosteal abscesses.
Conclusions:
- Prehospitalization antibiotic therapy for suppurative AOM in children may not influence the subsequent development of acute mastoiditis.
- Most bacteria isolated from patients with subperiosteal abscesses remained sensitive to prescribed antibiotics.
Objective:
To determine the relationship between prior antibiotic use and the development of acute mastoiditis (AM) in children.
Design:
Retrospective review.
Setting:
Tertiary pediatric center.
Patients:
We identified 129 patients with AM who were admitted to our center between 1996 and 2005.
Main Outcome Measure:
Proportion of children who developed AM.
Results:
A total of only 67 patients (51.9%) had undergone any antimicrobial treatment prior to hospital admission. In 1996, 64% of patients with AM had received antibiotics for acute otitis media (AOM) prior to admission (n = 7 of 11), but this percentage had steadily decreased to 27% by 2005 (n = 4 of 15). The yearly number of cases of AM treated in our institution has remained stable over this period. A subperiosteal abscess was identified in 45 patients (34.9%), while the remainder (n = 84) had postauricular inflammation only (65.1%). Nineteen patients with a subperiosteal abscess (42%) and 48 patients without a subperiosteal abscess (57%) had undergone prehospitalization antimicrobial therapy for suppurative AOM. There was no significant difference in antibiotic use between the numbers of patients with or without a subperiosteal abscess. Regarding the sensitivity of bacteria isolated from patients with a subperiosteal abscess, only 1 patient was infected with an organism that was not sensitive to the prehospitalization antibiotic prescribed.
Conclusion:
Use of antibiotics to treat suppurative AOM in children might not influence the subsequent development of AM.
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