National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media?

Zuijlen, Diederick A. Van; Schilder, Anne G. M.; Balen, F.A.M. van; Hoes, Arno W.

doi:10.1097/00006454-200102000-00004

Cited by 227 publications

(119 citation statements)

References 22 publications

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“…As far as the delay of antibiotic treatment is concerned, it is not easy to extrapolate the results obtained in the animal model to human medicine, but our results suggest that if antibiotics are indicated in cases of AOM they should be administered very early, as recently proposed by Handley (14), especially in countries where the organism may have diminished susceptibility to the administered drug. This attitude should lead to the achievement of maximal efficacy and at the same time may prevent serious complications (28).…”

Section: Discussionmentioning

confidence: 99%

Effect of Antibiotic Treatment Delay on Therapeutic Outcome of Experimental Acute Otitis Media Caused by Streptococcus pneumoniae Strains with Different Susceptibilities to Amoxicillin

Parra¹,

Ponte²,

Cenjor

et al. 2004

Antimicrob Agents Chemother

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Section: Discussionmentioning

confidence: 99%

Effect of Antibiotic Treatment Delay on Therapeutic Outcome of Experimental Acute Otitis Media Caused by Streptococcus pneumoniae Strains with Different Susceptibilities to Amoxicillin

Parra¹,

Ponte²,

Cenjor

et al. 2004

Antimicrob Agents Chemother

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“…Early therapy clearly correlated with improved effectiveness; therefore, if antibiotics are indicated, they should be administered, combined with ibuprofen, as early as possible. This therapeutic approach, which has been proposed by some authors (19,20), may lead to achieving maximal effectiveness and preventing serious complications (21).…”

Section: Discussionmentioning

confidence: 99%

Impact of Ibuprofen Therapy in the Outcome of Experimental Pneumococcal Acute Otitis Media Treated With Amoxicillin or Erythromycin

et al. 2006

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ABSTRACT:The impact of ibuprofen combined with amoxicillin or erythromycin for therapy of penicillin-resistant pneumococcal acute otitis media (AOM) was evaluated in a gerbil model. Ibuprofen (at 2.5 or 7.5 mg/kg, orally) and/or amoxicillin or erythromycin (5 mg/kg each, s.c.) were administered at 5 h (early therapy, as singledose regimen) or at 18 h (delayed therapy, five doses) postinoculation (PI). Each antibiotic alone and combined with ibuprofen was more effective administered as early regimen than as delayed treatment when evaluating the presence of otorrhea, otoscopic aspect, culturepositive and bacterial counts in middle ear (ME) samples, and loss of body weight. There was a trend for a better bacteriological outcome in animals receiving amoxicillin or erythromycin and ibuprofen, especially with the high dose. Such a dose of ibuprofen, associated with each antibiotic regimen, also preserved the animal well-being, avoiding a great weight loss in comparison to those receiving the antibiotic alone but a statistically significant difference was only observed for animals receiving delayed therapy with erythromycin and high-dose ibuprofen. In conclusion, ibuprofen combined with antibiotics seemed to improve the outcome of this experimental pneumococcal AOM. A OM is one of the most frequently diagnosed infectious diseases and the most common reason for antibiotic prescriptions written for children in many countries (1). Most experts recommend empirical antimicrobial treatment of AOM in children to eradicate the pathogen and the use of an anti-inflammatory or analgesic drug such as ibuprofen or acetaminophen to relieve the symptoms (2,3). Acetaminophen acts as a weak inhibitor of the synthesis of prostaglandins inhibiting cyclooxygenase (COX)-2-dependent pathways (4). In contrast, ibuprofen inhibits both COX-1 and COX-2 having more potent analgesic and anti-inflammatory effects (5). We previously demonstrated using an experimental AOM model caused by Streptococcus pneumoniae that acetaminophen combined with amoxicillin/clavulanic acid or erythromycin had neither a synergistic nor an antagonistic effect on the antipneumococcal activity (6). Therefore, use of acetaminophen to alleviate ear pain and decrease body temperature (3) may be advocated alone or combined with an antibiotic in the management of AOM. We selected ibuprofen, a potent antiinflammatory drug, to determine its effect when combined with antimicrobial treatment on the outcome of penicillinresistant pneumococcal AOM in a gerbil model. METHODS Bacteria.A strain of S. pneumoniae serotype 23 F [minimum inhibitory concentration (MIC) for benzylpenicillin ϭ 2 g/mL] isolated from a bacteremic patient was used.Pharmacological compounds. Ibuprofen sodium salt and erythromycin (Sigma Chemical Co., St. Louis, MO) and amoxicillin trihydrate (GlaxoSmithKline, Worthing, UK) were used for in vitro studies. For in vivo (therapeutic) use, Junifen, an ibuprofen suspension (Boots Healthcare International, Nottingham, UK), was used diluted with sterile distilled water ...

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“…32 • Mastoiditis: Children in all treatment groups could develop acute mastoiditis, although a study has shown that rates are almost double in the Netherlands compared with Great Britain and the United States. 33 One half of the national rates from that study (Table 1) were used in the model, as only 50% of children with mastoiditis have preceding AOM. [41][42][43][44] The Netherlands' rate was applied in the watchful waiting and delayed prescription interventions, and the US rate in the amoxicillin interventions.…”

Section: R E At Men T O P T Ions F or Acu T E Ot I T Is Mediamentioning

confidence: 99%

Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media

Coco¹

2007

The Annals of Family Medicine

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PURPOSE This study evaluated the costs and utility of observation and routine antibiotic treatment options for children with acute otitis media. METHODSThe cost-effectiveness analysis was performed among children aged 6 months to 12 years seen in primary care offi ces. The interventions studied were watchful waiting as practiced in the Netherlands, delayed prescription, 5 days of amoxicillin, and 7 to 10 days of amoxicillin. The main outcome measure was cost per quality-adjusted life-year (QALY). RESULTSIn the base case analysis, delayed prescription was the least costly option and 7 to 10 days of amoxicillin was the most effective. The incremental cost utility ratio (ICUR) of 7 to 10 days of amoxicillin compared with delayed prescription was $56,000 per QALY gained. Watchful waiting and 5 days of amoxicillin were inferior options. The results were sensitive to the rate of nonattendance in the delayed prescription strategy: when the rate was less than 23%, watchful waiting was the least costly option and delayed prescription was an inferior option. Probabilistic sensitivity analysis, in which all model variables were simultaneously varied, showed with 95% certainty that compared with delayed prescription, 7 to 10 days of amoxicillin had a 61% probability of having an ICUR of greater than $50,000 per QALY gained, and watchful waiting had a 23% probability of having an ICUR of less than $50,000 per QALY gained.CONCLUSIONS Economically, an approach to the treatment of acute otitis media with either an initial period of observation or routine treatment with amoxicillin is reasonable. INTRODUCTIONA cute otitis media (AOM), or infl ammation of the middle ear, is responsible for 13.6 million pediatric offi ce visits annually in the United States 1 at an estimated annual cost of $2.98 billion in 1995. 2 In the United States, AOM is routinely treated with antibiotics and, because of the large number of visits, accounts for a considerable percentage of all outpatient antimicrobial prescriptions. 3,4 The benefi t of antibiotic treatment of AOM is controversial, however, for children older than 6 months. [5][6][7][8] Meta-analyses and systematic reviews of the literature have found a spontaneous resolution rate of 81% compared with a 93% resolution rate with antibiotic therapy, for an overall benefi t of shortening the course of AOM by 1 day in 1 of 8 children treated. [9][10][11][12] Suppurative complications, such as acute mastoiditis, are rare, 13 and the extensive use of antibiotics contributes to bacterial resistance. [14][15][16][17][18][19][20] Several recent reports document the effi cacy and safety of 2 alternative, observational approaches to routine use of antibiotics: delayed prescription and watchful waiting. [21][22][23][24] These approaches involve waiting for 72 hours to see if symptoms improve before instituting antibiotic therapy. Routine antibiotic treatment is the usual option for treating AOM in the United States, but recent guidelines have allowed for observation of chil- T R E AT MEN T O P ...

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National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media?

Cited by 227 publications

References 22 publications

Effect of Antibiotic Treatment Delay on Therapeutic Outcome of Experimental Acute Otitis Media Caused by Streptococcus pneumoniae Strains with Different Susceptibilities to Amoxicillin

Effect of Antibiotic Treatment Delay on Therapeutic Outcome of Experimental Acute Otitis Media Caused by Streptococcus pneumoniae Strains with Different Susceptibilities to Amoxicillin

Impact of Ibuprofen Therapy in the Outcome of Experimental Pneumococcal Acute Otitis Media Treated With Amoxicillin or Erythromycin

Cost-Effectiveness Analysis of Treatment Options for Acute Otitis Media

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