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Prognostic effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis
E Carmel1, J H Curotta1, A T Cheng1
1Department of Paediatric Otolaryngology,Children's Hospital at Westmead,Sydney,Australia.
Insights
Pre-admission antibiotic treatment for pediatric acute mastoiditis increases complication risk. Post-admission antibiotic therapy for 10 days is recommended for uncomplicated cases to prevent sequelae.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Pharmacology
Background:
- Acute mastoiditis is a serious middle ear infection in children.
- Antibiotic therapy is the cornerstone of treatment, but its timing and duration can influence outcomes.
- Understanding the impact of pre- and post-admission antibiotic use is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the impact of antibiotic treatment administered before and after hospital admission on the short- and long-term outcomes of pediatric acute mastoiditis.
- To identify risk factors for complications in children with acute mastoiditis.
Main Methods:
- Retrospective study design.
- Analysis of data from 88 children diagnosed with acute mastoiditis between 2003 and 2012.
- Investigation of the relationship between antibiotic therapy timing and the development of short- and long-term sequelae.
Main Results:
- The median duration of post-discharge antibiotic therapy was 10 days.
- No sequelae were observed within two weeks of completing antibiotic therapy.
- 14 out of 40 patients experienced significant long-term sequelae, including recurrent otorrhoea, acute otitis media, and need for ventilation tube insertion.
- Complication rates were significantly higher in patients who received pre-admission antibiotics (52%) compared to those who did not (27%).
Conclusions:
- Pediatric patients with acute mastoiditis treated with antibiotics prior to hospital admission face an elevated risk of developing complications.
- A 10-day course of oral antibiotic therapy following hospital discharge is recommended for uncomplicated acute mastoiditis.
- Early antibiotic administration may be associated with increased long-term complications.
Objective:
To evaluate the effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis.
Design:
Retrospective study.
Method:
Eighty-eight children with acute mastoiditis, from 2003 to 2012, were studied to investigate the effect of antibiotic therapy on short and long-term sequelae.
Results:
The median period of antibiotic therapy immediately following hospital discharge was 10 days (range, 5-49 days; standard deviation = 7.46). There were no sequelae within the fortnight following antibiotic therapy completion, but 14 of 40 patients had significant sequelae thereafter, including recurrent otorrhoea, acute otitis media and ventilation tube insertion requirement. Complication rates were significantly higher among patients who had pre-admission antibiotic therapy (52 per cent), compared to patients previously untreated (27 per cent).
Conclusion:
Paediatric acute mastoiditis patients treated with antibiotic therapy prior to admission are at higher risk for complication development. The advised time period for oral antibiotic therapy following hospital discharge remains as 10 days in all cases of uncomplicated acute mastoiditis.
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