The Relationship Between Acute Mastoiditis and Antibiotic Use for Acute Otitis Media in Children—Invited Commentary

Abstract

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.