Restricting the use of antibiotics in children with acute otitis media may be associated with higher rates of mastoiditis, said Dr. Diederick A. Van Zuijlen and his associates of University Medical Center Utrecht (Netherlands).
But this adds up to only about two extra cases of acute mastoiditis per 100,000 per year. This finding doesn't necessarily support abandonment of the "watchful waiting" strategy of acute otitis media (AOM) management used by most Dutch physicians. The advantages of watchful waiting include fewer antibiotic-associated costs, side effects, and resistance rates (Pediatr. Infect. Dis. J. 20:140-44, 2001).
The incidence rates of acute mastoiditis in children aged 14 years and younger during 1991-1998 ranged from 1.2 to 2 per 100,000 children per year in countries where antibiotics are prescribed for more than 96% of all children: the Unit ed States, the United Kingdom, Canada, and Australia.
The rate was 3.5 per 100,000 children in Norway, (where 67% of children with AOM get antibiotic prescriptions), 4.2 per 100,000 in Denmark (76% of children), and 3.8 per 100,000 in the Nether lands (31% of children).
Guidelines from the Dutch College of General Practitioners advise antibiotics only for children with a complicated course of AOM or for those at greater risk of complications.
Even if restrictive use of antibiotics for AOM is responsible for the difference in incidence rates, watchful waiting is not necessarily a bad idea. Acute mastoiditis is a serious AOM complication, but it can be treated in most cases with broad-spectrum intravenous antibiotics and myringotomy. In a recent study, only 25% of acute mastoiditis cases eventually require mastoidectomy.
At least 2,500 antibiotic prescriptions would be needed to prevent one episode of acute mastoiditis. Yet antibiotic use clearly promotes resistance: The percentage of penicillin resistant Streptococcus pneumoniae in the Netherlands in 1995 was 1.1%, compared with 27.5% in the United States.
COPYRIGHT 2001 International Medical News Group
COPYRIGHT 2001 Gale Group