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Article: Effect of antibiotics for otitis media on mastoiditis in children: A retrospective cohort study using the united kingdom general practice research database

TitleEffect of antibiotics for otitis media on mastoiditis in children: A retrospective cohort study using the united kingdom general practice research database
Authors
KeywordsAntibiotics
Mastoiditis
Otitis media
Pediatrics
Prescribing
Issue Date2009
PublisherAmerican Academy of Pediatrics. The Journal's web site is located at http://pediatrics.aappublications.org/
Citation
Pediatrics, 2009, v. 123 n. 2, p. 424-430 How to Cite?
AbstractBACKGROUND. Information is needed on whether mastoiditis has increased in association with the decline in antibiotics prescribed to children by primary care physicians in the United Kingdom. OBJECTIVE. To determine time trends in mastoiditis incidence, the frequency of antecedent otitis media, and the effect of antibiotics for otitis media on the risk of mastoiditis in children. PATIENTS AND METHODS. We conducted a retrospective cohort study by using the UK General Practice Research Database. Children aged 3 months to 15 years between 1990 and 2006 were included. Risk of mastoiditis within 3 months after otitis media diagnosis and the protective effect of antibiotics were determined. RESULTS. There were 2 622 348 children within the General Practice Research Data- base;854 had mastoiditis, only one third of whom (35.7%) had antecedent otitis media. Mastoiditis incidence remained stable between 1990 and 2006 (∼1.2 per 10 000 child-years). Risk of mastoiditis, after otitis media, was 1.8 per 10 000 episodes (139 of 792 623) after antibiotics compared with 3.8 per 10 000 (149 of 389 649) without antibiotics, and increased with age. Antibiotics halved the risk of mastoiditis. General practitioners would need to treat 4831 otitis media episodes with antibiotics to prevent 1 child from developing mastoiditis. If antibiotics were no longer prescribed for otitis media, an extra 255 cases of childhood mastoiditis would occur, but there would be 738 775 fewer antibiotic prescriptions per year in the United Kingdom. CONCLUSIONS. Most children with mastoiditis have not seen their general practitioner for otitis media. Antibiotics halve the risk of mastoiditis, but the high number of episodes needing treatment to prevent 1 case precludes the treatment of otitis media as a strategy for preventing mastoiditis. Although mastoiditis is a serious disease, most children make an uncomplicated recovery after mastoidectomy or intravenous antibiotics. Treating these additional otitis media episodes could pose a larger public health problem in terms of antibiotic resistance. Copyright © 2009 by the American Academy of Pediatrics.
Persistent Identifierhttp://hdl.handle.net/10722/132879
ISSN
2015 Impact Factor: 5.196
2015 SCImago Journal Rankings: 3.226
ISI Accession Number ID
Funding AgencyGrant Number
Department of Health Public Health Career Scientist Award
European Commission
Funding Information:

We thank the general practitioners who contributed data to the GPRD.

References

 

DC FieldValueLanguage
dc.contributor.authorThompson, PLen_HK
dc.contributor.authorGilbert, REen_HK
dc.contributor.authorLong, PFen_HK
dc.contributor.authorSaxena, Sen_HK
dc.contributor.authorSharland, Men_HK
dc.contributor.authorWong, ICKen_HK
dc.date.accessioned2011-04-04T07:57:45Z-
dc.date.available2011-04-04T07:57:45Z-
dc.date.issued2009en_HK
dc.identifier.citationPediatrics, 2009, v. 123 n. 2, p. 424-430en_HK
dc.identifier.issn0031-4005en_HK
dc.identifier.urihttp://hdl.handle.net/10722/132879-
dc.description.abstractBACKGROUND. Information is needed on whether mastoiditis has increased in association with the decline in antibiotics prescribed to children by primary care physicians in the United Kingdom. OBJECTIVE. To determine time trends in mastoiditis incidence, the frequency of antecedent otitis media, and the effect of antibiotics for otitis media on the risk of mastoiditis in children. PATIENTS AND METHODS. We conducted a retrospective cohort study by using the UK General Practice Research Database. Children aged 3 months to 15 years between 1990 and 2006 were included. Risk of mastoiditis within 3 months after otitis media diagnosis and the protective effect of antibiotics were determined. RESULTS. There were 2 622 348 children within the General Practice Research Data- base;854 had mastoiditis, only one third of whom (35.7%) had antecedent otitis media. Mastoiditis incidence remained stable between 1990 and 2006 (∼1.2 per 10 000 child-years). Risk of mastoiditis, after otitis media, was 1.8 per 10 000 episodes (139 of 792 623) after antibiotics compared with 3.8 per 10 000 (149 of 389 649) without antibiotics, and increased with age. Antibiotics halved the risk of mastoiditis. General practitioners would need to treat 4831 otitis media episodes with antibiotics to prevent 1 child from developing mastoiditis. If antibiotics were no longer prescribed for otitis media, an extra 255 cases of childhood mastoiditis would occur, but there would be 738 775 fewer antibiotic prescriptions per year in the United Kingdom. CONCLUSIONS. Most children with mastoiditis have not seen their general practitioner for otitis media. Antibiotics halve the risk of mastoiditis, but the high number of episodes needing treatment to prevent 1 case precludes the treatment of otitis media as a strategy for preventing mastoiditis. Although mastoiditis is a serious disease, most children make an uncomplicated recovery after mastoidectomy or intravenous antibiotics. Treating these additional otitis media episodes could pose a larger public health problem in terms of antibiotic resistance. Copyright © 2009 by the American Academy of Pediatrics.en_HK
dc.languageengen_US
dc.publisherAmerican Academy of Pediatrics. The Journal's web site is located at http://pediatrics.aappublications.org/en_HK
dc.relation.ispartofPediatricsen_HK
dc.subjectAntibioticsen_HK
dc.subjectMastoiditisen_HK
dc.subjectOtitis mediaen_HK
dc.subjectPediatricsen_HK
dc.subjectPrescribingen_HK
dc.titleEffect of antibiotics for otitis media on mastoiditis in children: A retrospective cohort study using the united kingdom general practice research databaseen_HK
dc.typeArticleen_HK
dc.identifier.emailWong, ICK: wongick@hku.hken_HK
dc.identifier.authorityWong, ICK=rp01480en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1542/peds.2007-3349en_HK
dc.identifier.pmid19171605-
dc.identifier.scopuseid_2-s2.0-61549111854en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-61549111854&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume123en_HK
dc.identifier.issue2en_HK
dc.identifier.spage424en_HK
dc.identifier.epage430en_HK
dc.identifier.eissn1098-4275-
dc.identifier.isiWOS:000262678700002-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridThompson, PL=25923668200en_HK
dc.identifier.scopusauthoridGilbert, RE=7401932225en_HK
dc.identifier.scopusauthoridLong, PF=7201512275en_HK
dc.identifier.scopusauthoridSaxena, S=12774236400en_HK
dc.identifier.scopusauthoridSharland, M=7006566942en_HK
dc.identifier.scopusauthoridWong, ICK=7102513915en_HK
dc.identifier.citeulike3998942-

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