Related Experiment Video
Updated: Dec 26, 2025
Following in Real Time the Impact of Pneumococcal Virulence Factors in an Acute Mouse Pneumonia Model Using Bioluminescent Bacteria
Published on: February 23, 2014
Antibiotic use and serious complications following acute otitis media and acute sinusitis: a retrospective cohort
Rebecca Cushen1, Nick A Francis2
1Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff; consultant in public health medicine, Cwm Taf Morgannwg Public Health Team, Public Health Wales, Glanrhyd Hospital, Bridgend.
Background:
Most people with acute otitis media (AOM) and acute sinusitis (AS) do not benefit from antibiotics, and GPs are under increasing pressure to reduce antibiotic prescribing. Concern about the risk of complications can drive unnecessary prescribing.
Aim:
To describe the incidence of serious complications following AOM and AS, and to determine whether antibiotics are protective.
Design And Setting:
This was a retrospective cohort study using the Clinical Practice Research Datalink database to identify patients diagnosed in general practice with AOM or AS between 1 January 1982 and 31 December 2012.
Method:
The incidence of brain abscess and acute mastoiditis following AOM, and of brain abscess and orbital cellulitis following AS, were calculated, as was the association between antibiotics and the development of these complications and numbers needed to treat (NNT).
Results:
The incidence of brain abscess and acute mastoiditis following AOM were 0.03 (95% confidence interval [CI] = 0.01 to 0.20) and 5.62 (95% CI = 4.81 to 6.56) per 10 000 AOM episodes, respectively. The incidence of brain abscess and orbital cellulitis following AS was 0.11 (95% CI = 0.05 to 0.26) and 1.50 (95% CI = 1.17 to 1.90) per 10 000 AS episodes, respectively. Antibiotic prescription for AOM was associated with lower odds of developing acute mastoiditis (odds ratio [OR] 0.54; 95% CI = 0.37 to 0.79); NNT to prevent one case was 2181 (95% CI = 1196 to 5709). Antibiotic prescribing for AS was associated with lower odds of subsequent brain abscess (OR 0.12; 95% CI = 0.02 to 0.70); NNT to prevent one case was 19 988 (95% CI = 4951 to 167 099). No significant association between antibiotic prescription and development of orbital cellulitis following AS were found (OR 0.56; 95% CI = 0.27 to 1.12).
Conclusion:
Serious complications following AOM and AS are rare. Antibiotics are associated with lower odds of developing complications, but the NNT are large.
Insights
Serious complications from acute otitis media (AOM) and acute sinusitis (AS) are rare. While antibiotics may reduce complication risks, the large numbers needed to treat suggest cautious prescribing for these common infections.
Area of Science:
- Otolaryngology
- Infectious Diseases
- General Practice
Background:
- Antibiotic overuse for acute otitis media (AOM) and acute sinusitis (AS) is a concern, driven partly by fears of serious complications.
- General practitioners (GPs) face pressure to reduce antibiotic prescribing for AOM and AS.
Purpose of the Study:
- To determine the incidence of serious complications following AOM and AS.
- To evaluate the protective effect of antibiotic use against these complications.
Main Methods:
- Retrospective cohort study utilizing the Clinical Practice Research Datalink database.
- Inclusion criteria: patients diagnosed with AOM or AS in general practice between 1982 and 2012.
- Analysis included incidence calculations and association between antibiotic prescription and complications (brain abscess, acute mastoiditis, orbital cellulitis).
Main Results:
- Serious complications such as brain abscess and acute mastoiditis following AOM are rare (e.g., 5.62 per 10,000 AOM episodes for mastoiditis).
- Brain abscess and orbital cellulitis following AS were also infrequent (e.g., 1.50 per 10,000 AS episodes for orbital cellulitis).
- Antibiotic use was associated with reduced odds of mastoiditis (AOM) and brain abscess (AS), but with large numbers needed to treat (NNT).
Conclusions:
- Serious complications following AOM and AS are uncommon events.
- Antibiotic prescribing shows a statistical association with a lower risk of developing rare complications.
- The large NNT indicates that the benefits of routine antibiotic use for preventing these rare complications may be outweighed by risks of antibiotic resistance and side effects.
More Related Videos
Related Concept Videos
01:26Tonsillitis II: Management
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...