Children with middle ear infections, also known as otitis media, should not be given antibiotics to prevent a type of skull bone infection called mastoiditis, new research suggests. It’s not because the antibiotics don’t work, but rather because the problem is so rare that it’s just not worthwhile, according to senior investigator Dr. Ian Chi Kei Wong and associates.

Mastoiditis is an infection of the mastoid process, a part of the skull that extends behind the ear. The disease is usually caused by untreated middle ear infections and was a leading cause of death during childhood. Treatment typically involves medications, surgery, or both. Untreated, the infection can spread to nearby structures, including the brain, and cause serious complications.

“The use of antibiotics for otitis media halves the risk of mastoiditis,” investigator Dr. Ian Chi Kei Wong told Reuters Health. “However, since mastoiditis is an uncommon disease; thousands of children will need to be treated with antibiotics in order to prevent one case.”

Wong of the Centre for Paediatric Pharmacy Research, London and co-investigators came to this conclusion after analyzing data on more than 2.6 million children from 1990 to 2006.

The rate of mastoiditis at about 1.2 cases per 10,000 children per year remained stable over the period in question, according to the report in the journal Pediatrics. As noted, mastoiditis was about half as common in children who were treated with antibiotics than in those who were untreated.

The researchers point out that although mastoiditis is a serious disease, “most children make an uncomplicated recovery after (surgery or) antibiotics. Treating these additional otitis media episodes could pose a larger public health problem in terms of antibiotic resistance.”

In light of these findings, continued Wong, “we concluded that children diagnosed with acute otitis media should not routinely be prescribed antibiotics as the initial treatment.”

SOURCE: Pediatrics, February 2009.