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Allergy, immunology and infectious diseases

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ALL/THUR/01 EFFECT OF ANTIBIOTICS FOR OTITIS MEDIA ON MASTOIDITIS IN CHILDREN: RETROSPECTIVE COHORT STUDY USING THE UK GENERAL PRACTICE RESEARCH DATABASE

1PL Thompson, 2R Gilbert, 1P Long, 3S Saxena, 4M Sharland, 1I. Wong. 1Centre for Paediatric Pharmacy Research, School of Pharmacy, London, UK; 2Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK; 3Department of Primary Care and Social Medicine, Imperial College London, London, UK; 4Paediatric Infectious Diseases Unit, St George’s Hospital, London, UK

Background: It is unknown whether the decline in antibiotics prescribed to children by general practitioners (GPs) in the United Kingdom has been associated with a rise in rare complications of infections, such as mastoiditis.

Aims: To determine secular trends in the incidence of mastoiditis, the frequency of antecedent otitis media and the effect of antibiotic treatment for otitis media on the risk of mastoiditis in children.

Methods: A retrospective cohort study was conducted using the UK General Practice Research Database. Children aged 3 months to 15 years between 1990 and 2006 were eligible for inclusion. Children temporarily registered with their general practice were excluded. The incidence of mastoiditis and prevalence of antecedent otitis media in affected children was determined. The risk of developing mastoiditis within the 3 months following an episode of otitis media and the protective effect of antibiotic treatment was estimated, based on a cohort of all otitis media episodes.

Results: 854 children had mastoiditis (incidence 1.3 per 10 000 child-years), only a third of whom (35.7%; 305/854) had antecedent otitis media. The risk of mastoiditis, following otitis media, was 1.8 per 10 000 episodes (139/792 623) after antibiotic treatment compared with 3.8 per 10 000 (149/389 649) without treatment and increased with age (p<0.01). Antibiotics were protective for mastoiditis: the odds ratio (adjusted for gender, age group and otitis media status) was 0.56 (95% CI 0.44 to 0.71). GPs would need to …

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