Otitis media is not a good rationale for giving antibiotics

Clinical question Is the detection and treatment of otitis media associated with a decrease in the development of mastoiditis?

Bottom line The prevention of mastoiditis is not a good reason to give antibiotics to children with otitis media. Most children who develop mastoiditis will not have had otitis media diagnosed in the previous 3 months. For children with otitis media, one episode of mastoiditis is prevented for every 4,831 children who are treated. (Level of evidence = 2b)

Synopsis The researchers conducting this study used data from a database of general practice records for more than 2.6 million children who are regular patients of an “up-to-standard” general practice in the United Kingdom. They searched the database for diagnoses of mastoiditis or reports of mastoidectomy in children aged 3 months to 15 years over a 17-year period. They identified 854 cases of mastoiditis, or 1.2 cases per 10,000 children per year. Only 36% of these children had a diagnosis of otitis media in the 3 months before this diagnosis. Analyzing a cohort of children with otitis media over the same period, they found that antibiotic treatment decreased the likelihood of the development of mastoiditis, though the numbers were small. There were only 288 cases of mastoiditis over the whole period in almost 465,000 children who had a total of 1.18 million diagnoses of otitis media. Translated, this means that one episode of mastoiditis is prevented for every 4,831 children who are treated.

frome: jaapa.com