National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media?
ABSTRACT Operating on the principle that most acute otitis media (AOM) episodes resolve without antibiotics, doctors in the Netherlands usually manage AOM in children with initial observation. Prescription of antibiotics is limited to children with a complicated course of AOM and those categorized as high risk. Consequently only 31% of patients with AOM receives antibiotics, compared with >90% in most other countries.
To substantiate the suggestion that this restrictive use of antibiotics leads to a higher incidence of acute mastoiditis.
A comparative study across several European countries, Canada, Australia and the United States was performed in the period 1991 to 1998. The incidence rate of acute mastoiditis was defined as the total number of patients age 14 years and younger discharged from all hospitals with the primary diagnosis of acute mastoiditis, during a specified period (usually 5 years), divided by the number of person years (py) in that same age range and period. The latter was calculated by totaling the midyear population estimate of children age 14 years and younger of each year. The 95% confidence intervals and incidence rate ratios were calculated to compare the observed rates.
The incidence rate of acute mastoiditis in the Netherlands, with a low antibiotic prescription rate for AOM, was 3.8/100,000 py; in Norway and Denmark, with high prescription rates, the incidence rate was comparable at 3.5/100,000 py and 4.2/100,000 py, respectively. In all other countries with very high prescription rates, incidence rates were considerably lower, ranging from 1.2 to 2.0/100,000 py. The incidence rate in the Netherlands was about twice that in the United States (rate ratio, 0.5).
The incidence rate of acute mastoiditis in the Netherlands is higher than in many countries with higher antibiotic prescription rates. Although the potential benefits of restricted use of antibiotics (i.e. cost reduction, fewer side effects from antibiotics and less antimicrobial resistance) are beyond dispute, such strategy may be associated with a somewhat higher incidence of acute mastoiditis.
[show abstract] [hide abstract]
ABSTRACT: During the last two decades, there has been an alarming worldwide increase of resistance to antibiotics of bacterial pathogens responsible for community-acquired infections. This dramatic evolution is generally attributed to the extensive use of antibiotics and the selective pressure on the bacterial strains. To decrease antibiotics resistance in the community, several approaches should be considered through: reducing unnecessary antibiotic prescriptions: inappropriate antibiotic treatments are becoming a major issue; however, few studies have shown a decrease of antibiotic resistance following a reduction of antibiotic use in the community;decreasing the prescriptions of the more selective antibiotic compounds for some bacterial species, eg macrolides and group A streptococcus (GAS), trimethoprim-sulfamethoxazole and pneumococcus; using an optimal dosage and duration of antibiotic regimens chosen; some studies have suggested that low dosage and long treatment duration could promote antibiotic resistance; and implementing the pneumococcal conjugate vaccines; several studies have shown a decline in the proportion of penicillin nonsusceptible Streptococcus pneumoniae isolated from invasive pneumococcal diseases or nasopharyngeal flora. The combination of these approaches, particularly the reduction of antibiotic use and pneumococcal immunization, could be synergistic.The Pediatric Infectious Disease Journal 11/2006; 25(10):977-80. · 3.58 Impact Factor
[show abstract] [hide abstract]
ABSTRACT: Mastoiditis, subperiosteal abscess and sigmoid vein thrombosis are the most common suppurative complications of acute otitis media (AOM). Luc's abscess, a subperiosteal temporal collection, is an infrequent complication with a particularly benign course. Two children, aged 5 years, presented with AOM complicated by an atypical abscess deep to the temporalis muscle, with no evidence for mastoid or zygomatic arch involvement. Computed tomographic scan was performed in only 1 child. In both children, treatment included antibiotic therapy, grommet insertion, and local surgical drainage of the temporalis abscess. In addition, a cortical mastoidectomy was performed in the patient who did not undergo computed tomography, based on clinical assessment. Clinical improvement, resolution of symptoms. Both patients recovered shortly following the surgical drainage. Mastoidectomy was poor in findings and was concluded as redundant. Luc's abscess is associated with relatively little morbidity and requires a more limited surgical intervention. Computed tomographic scan is of great value to evaluate the extent of the disease and prevent needless mastoidectomy.Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 07/2010; 31(5):776-9. · 1.44 Impact Factor
[show abstract] [hide abstract]
ABSTRACT: To determine whether treatment of acute mastoiditis in children using antibiotics combined with retroauricular puncture and grommet insertion is effective compared with "standard management" with mastoidectomy. Retrospective study. Tertiary pediatric center. We identified 50 patients younger than 14 years with acute mastoiditis (mean age, 32 months). Individuals with subacute mastoiditis and cholesteatoma were excluded from this study. All the children had received antibiotic drug treatment. Before 2002, a subperiosteal abscess (SA) was managed by mastoidectomy. Beginning in 2002, however, conservative management was initially attempted to avoid mastoidectomy. The proportion of cured children after conservative management of SA in acute mastoiditis. Acute mastoiditis occurred in 30 patients already treated with antibiotics before hospital admission. On examination, 1 child had facial palsy. All the patients except 1 (who had temporozygomatic swelling) had postauricular swelling. Myringotomy or retroauricular puncture isolated bacteria in 38 patients. Streptococcus pneumoniae was identified in 28 patients. Computed tomography (43 patients) diagnosed 31 SAs, including 3 cases of sigmoid sinus thrombosis and 1 subdural abscess. All the children were cured without complications regardless of the type of treatment. Comparing the periods before and after 2002, the number of SAs was similar (15 and 16, respectively), but the number of mastoidectomies was reduced (16 and 1, respectively). The hospital length of stay of patients who underwent aspiration was shorter than that of patients who underwent cortical mastoidectomy. Antibiotic drug use combined with retroauricular puncture and grommet insertion is an effective alternative to mastoidectomy in the treatment of acute mastoiditis with SA in children.Archives of otolaryngology--head & neck surgery 04/2011; 137(4):346-50. · 1.92 Impact Factor