Thompson, Paula Louise; (2009) Effect of antibiotics for otitis media on mastoiditis in children. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

Since the mid-1990s, UK campaigns have aimed to reduce antibiotic prescribing because of the threat posed to public health by antibiotic-resistant bacteria. In particular, common childhood infections, including otitis media, have been targeted. However, concerns have been raised that reducing antibiotic use may lead to increases in rare complications of bacterial infection, such as mastoiditis following otitis media. Thus, there was a need to examine the potential adverse effects of reduced antibiotic prescribing in children. This thesis presents the findings of two time-trend analyses, a case-review and a retrospective cohort study investigating community antibiotic prescribing and disease outcome in children between 1990 and 2007, using the General Practice Research Database and IMS MediPlus UK. Trends in condition-specific antibiotic prescribing were examined and the effect of antibiotics prescribed for the treatment of otitis media on the risk of developing mastoiditis was determined. Between 1995 and 2000 there was a marked reduction in antibiotic prescribing for the majority of conditions in children, including a 51% decrease for otitis media. Only one-third of children with mastoiditis had a record of otitis media within the three months preceding mastoiditis. The risk of mastoiditis following otitis media was never more than 16/10,000 otitis media episodes. Prescribing antibiotics for otitis media appeared to halve the risk of a child developing mastoiditis. However, the number of otitis media episodes needing antibiotics to prevent one case of mastoiditis (NNT) was excessive; on average, 4,831 otitis media episodes would need treatment. The low risk of mastoiditis and high NNT precludes the treatment of otitis media as a strategy to prevent mastoiditis. Completely stopping prescribing antibiotics for otitis media might lead to an additional 2 cases of mastoiditis/10,000 otitis media episodes. In the UK, this may total 255 extra cases of childhood mastoiditis/year, whilst reducing antibiotic usage by 738,775 prescriptions/year.

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