Severe Acute Mastoiditis Admission is Not Related to Delayed Antibiotic Treatment for Antecedent Acute Otitis Media

Grossman, Zachi; Zehavi, Yoav; Leibovitz, Eugene; Grisaru‐Soen, Galia; Shachor-Meyouhas, Yael; Kassis, Imad; Stein, Michal; Ephros, Moshe; Luder, Anthony; Bamberger, Ellen; Abozaid, Said; Srugo, Isaac; Miron, Dan

doi:10.1097/inf.0000000000000951

Cited by 21 publications

(15 citation statements)

References 19 publications

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“…In the literature reports, the percentage of patients treated with antibiotic before the onset of AM ranges from 30 to 68% [11,15,17,18,19,21,22,26,31].…”

Section: Discussionmentioning

confidence: 99%

“…Contrast-enhanced CT is estimated to have an 80% positive predictive value and a 90% negative predictive value in the diagnosis of intracranial complications [27]. Different opinions are presented with regard to indications to CT scans; as a result, the percentage of patients in whom CT scans were performed ranges from 0.5 to 86% [11,12,17,18,20,22,23,33]. In a Danish study in a population of 214 patients, CT scan was performed in only one case [15].…”

Section: Discussionmentioning

confidence: 99%

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Acute mastoiditis in children population

Zonenberg¹,

Hassmann‐Poznańska

Skotnicka

et al. 2019

Pol Otorhino Rev

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Aim: The aim of the study was to perform a retrospective analysis of the medical documentation of patients treated for acute mastoiditis (AM) at the Department of Pediatric Otolaryngology in Bialystok and to review the available literature on this subject so as to determine optimum AM management principles. Material and methods:A retrospective analysis of 40 patients treated for AM in 2001-2017 was performed. Patient enrollment was based on the AM diagnostic criteria established by Anthonsen et al [15]. results:The mean age of the subjects was 46 months, with 37% of children being less than 2 years old. No previous episodes of acute otitis media (AOM) had been reported in 2/3 of cases. Prior to hospital admission, antibiotics had been administered to 69% of patients. In laboratory investigations, 95% of patients presented with elevated inflammation markers (CRP, leukocytosis), with the values of these markers being higher in patients qualified for surgery. Indications for computed tomography (CT) scans included lack of improvement following 48 hours of conservative treatment or the presence of symptoms of subperiosteal abscesses. CT scans were performed in 35% of patients. Conservative treatment alone was administered to 24 patients (60%); this included myringotomy with/without ventilation tube insertion and intravenous antibiotic therapy. Ceftriaxone was the most commonly used antibiotic, being administered to 75% of patients. Mastoidectomy was required in 16 patients. The most common indication (30%) for mastoidectomy consisted in the presence of subperiosteal abscess. conclusion:In non-complicated cases of AM, there is no need for routine performance of CT scans; myringotomy with or without insertion of ventilation drains should be performed and empirical intravenous antibiotic therapy should be started.In the presence of a subperiosteal abscess, a contrast-enhanced CT scan and mastoidectomy are recommended. Deterioration of patient's condition or lack of improvement after 48 hours of conservative treatment requires a CT scan being performed and the decision on potential mastoidectomy being made on the basis of the scan. Keywords:acute mastoiditis, children, acute otitis media, treatment streszczenie: cel: Celem pracy była analiza retrospektywna dokumentacji chorych leczonych z powodu ostrego zapalenia wyrostka sutkowatego (OZWS) w Klinice Otolaryngologii Dziecięcej w Białymstoku, jak również dostępnego piśmiennictwa na ten temat, w celu określenia optymalnych zasad postępowania w OZWS. Materiał i metody:Analiza retrospektywna 40 pacjentów leczonych z powodu OZWS w latach 2001-2017. Kryteria włączenia pacjentów przyjęto za Anthonsen i wsp.[15]. wyniki: Średni wiek badanych wynosił 46 miesięcy, 37% dzieci miało mniej niż 2 lata. 2/3 przypadków nie było poprzedzonych wcześniejszymi epizodami OMA. 69% chorych otrzymywało antybiotyk przed przyjęciem do szpitala. W badaniach laboratoryjnych u 95% chorych stwierdzono podwyższone wykładniki stanu zapalnego (CRP, leukocytoza), ich wartość była wyższa wśród chorych zak...

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“…In the literature reports, the percentage of patients treated with antibiotic before the onset of AM ranges from 30 to 68% [11,15,17,18,19,21,22,26,31].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute mastoiditis in children population

Zonenberg¹,

Hassmann‐Poznańska

Skotnicka

et al. 2019

Pol Otorhino Rev

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“…Die Kinder, denen sofort ein Antibiotikum verabreicht wurde, zeigten eine höhere Rate an Rezidiven (29 % versus 8,7 %, p = 0,0021), mehr Komplikationen (19,5 % versus 10,5 %, p = 0,12), höhere Raten an chirurgischen Eingriffen (30 % versus 10 %, p = 0,0033) und mehr Krankenhausaufenthalte über 6 Tage (37 % versus 29 %, p = 0,28). Auch wenn die Rezidivhäufigkeit herausgerechnet wurde, hatten die Kinder, die sofort Antibiotika erhielten, ein höheres OP-Risiko (relative risk: 3,2, 95 % Konfidenzintervall: 1,4-7,0) [20]. Hier kann eine Umkehr der Verursachung nicht ausgeschlossen werden.…”

Section: Verlaufunclassified

Fallbericht: Einsatz von Antibiotika bei Kindern mit Pneumonie

Martin¹

2017

Zeitschrift für Komplementärmedizin

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ZusammenfassungEin 8-jähriger Junge mit Lobärpneumonie wurde stationär mit Anthroposophika, aber ohne Antipyretika oder Antibiotika behandelt. Der Verlauf wurde anhand sonografischer Kontrollen beurteilt. Auch vorangegangene akute Infektionen (Otitis mediaacutaperforata, Pneumonie, Angina tonsillaris) wurden ohne Antibiotika oder Antipyretika behandelt. Zur Behandlung einer Borreliose im Vorfeld erhielt der Junge jedoch Antibiotika. Folgende Punkte werden in dem Fallbericht unter anderem diskutiert: Vitamin-D-Mangel, antibiotische Behandlungen, Fieber und Fiebersenkung, sonografische Diagnosestellung und Verlaufskontrollen. Vor dem Hintergrund der steigenden Rate von Antibiotika-Resistenzen soll dieser Fall zur Diskussion beitragen, wann Antibiotika notwendig sind und wann nicht.

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“…In the late 1980s the traditional antibiotic treatment for AOM was accused of contributing to the diffusion of drug resistant pathogens, moreover AOM showed to have high spontaneous resolution rates [ 10 ]. Therefore many scientific societies proposed their guidelines about diagnosis and treatment for AOM, every author strongly recommended pain management and suggested an observational management in low risk patients consisting in deferring antibacterial treatment for 48–72 h, the so call “watchful waiting strategy” [ 9 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Acute mastoiditis in an Italian pediatric tertiary medical center: a 15 – year retrospective study

et al. 2018

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BackgroundAcute mastoiditis is the main suppurative complication of acute otitis media. Its incidence ranges from 1.2 to 4.2/100.000 children/year and a rise has been reported in the last years. There are controversial data regarding risk factors for mastoiditis and its complications.Aim of the study: to evaluate demographics and clinical characteristics of children with acute mastoiditis and to identify possible risk factors for complications.MethodsWe retrospectively reviewed medical charts of all the children aged 1 month-14 years admitted to our Paediatric Emergency Department from January 2002 to December 2016.ResultsOne hundred forty-seven cases (97 males and 50 females) were included in the analysis, mean age was 4.8 ± 3.6 years and 28.2% of the patients were younger than 2 years. We found an increasing number of mastoiditis per year during the last 3 years of the study. Children younger than 2 years were less treated with antibiotics for acute otitis media or treated for a shorter period (p < 0.05), while they were treated at higher antibiotic’s dosage for mastoiditis (p < 0.01). Older children presented more frequently with symptoms such as earache or retroauricular pain (p < 0.0001, p < 0.001). We didn’t identify any risk factor for mastoiditis complications in our study.ConclusionsDespite the introduction of pneumococcal vaccines, the incidence of acute mastoiditis in our population has not been reduced during the last years. We have to face all the reasons why this condition is still relevant, such as antibiotic resistance, new pathogens involved and a possible role played by the implementations of therapeutic acute otitis media guidelines restricting the use of antibiotics in this disease. A particular attention should be given to younger children where signs and symptoms may be less pronounced, therefore acute otitis media or mastoiditis may be misunderstood and appropriate treatment delayed.

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Severe Acute Mastoiditis Admission is Not Related to Delayed Antibiotic Treatment for Antecedent Acute Otitis Media

Abstract: Delayed antibiotic treatment for antecedent AOM is not associated with an increase in severity parameters in subsequent acute mastoiditis admission.

Cited by 21 publications

References 19 publications

Acute mastoiditis in children population

Acute mastoiditis in children population

Fallbericht: Einsatz von Antibiotika bei Kindern mit Pneumonie

Acute mastoiditis in an Italian pediatric tertiary medical center: a 15 – year retrospective study

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