Antibiotic Treatment of Otitis Media May Not Prevent Mastoiditis

ntibiotic treatment of otitis media may not be indicated to prevent mastoiditis, according to the results of a retrospective cohort study reported in the February issue ofPediatrics.

The study cohort consisted of 2,622,348 children within the UK General Practice Research Database (GPRD) who were aged 3 months to 15 years between 1990 and 2006. The investigators assessed the risk for mastoiditis within 3 months after otitis media diagnosis and the protective effect of antibiotics.

Most children with mastoiditis had not seen their general practitioner for otitis media; among 854 children with mastoiditis, only 35.7% had antecedent otitis media.

Between 1990 and 2006, the incidence of mastoiditis remained stable at approximately 1.2 per 10,000 child-years. After otitis media, the risk for mastoiditis increased with age and was halved by antibiotics. The risk for mastoiditis after otitis media treated with antibiotics was 1.8 per 10,000 episodes (139/792,623) vs 3.8 per 10,000 episodes (149/389,649) without antibiotics.

To prevent 1 child from the development of mastoiditis, general practitioners would have to treat 4831 otitis media episodes with antibiotics. If otitis media were no longer treated with antibiotics in the United Kingdom, there would be an extra 255 cases of childhood mastoiditis but 738,775 fewer antibiotic prescriptions per year.

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