title: Severe Acute Mastoiditis Admission is Not Related to Delayed Antibiotic Treatment for Antecedent Acute Otitis Media.
abstract: BACKGROUND
  Delayed antibiotic treatment for acute otitis media (AOM) is recommended for children >6 months with nonsevere illness, no risk factors for complications or history of recurrent AOM. This study evaluates relationship between delayed antibiotic treatment for antecedent AOM and severity of subsequent acute mastoiditis admission.
  
  
  METHODS
  A prospective observational study of children aged 0-14 years admitted with acute mastoiditis to 8 hospitals between 2007 and 2012 calculates rates of severe acute mastoiditis admission [defined by ≥1 of the following: complication (mastoid subperiosteal abscess, brain abscess and sagittal vein thrombosis), need for surgical procedure and duration of admission >6 days].Severe acute mastoiditis admissions in children with antecedent AOM treated with immediate antibiotics were compared with those with delayed antibiotic treatment.
  
  
  RESULTS
  Antecedent AOM was diagnosed in 216 of 512 acute mastoiditis admissions (42.1%), of whom 159 (73%) immediately received antibiotics, and 57 (27%) had delayed antibiotic treatment. Higher rate of recurrent AOM was noted in the immediate compared with delayed antibiotic treatment group (29% vs. 8.7%, P = 0.0021). Complication rates were 19.5% versus 10.5% (P = 0.12), rates of surgical procedures required, 30% versus 10% (P = 0.0033); admission rates >6 days, 37% versus 29% (P = 0.28) for immediate antibiotic therapy and delayed antibiotic treatment. On logistic regression analysis, immediately treated AOM patients had increased need for surgery for acute mastoiditis with adjustment for history of recurrent AOM (relative risk: 3.2, 95% confidence interval: 1.4-7.0).
  
  
  CONCLUSIONS
  Delayed antibiotic treatment for antecedent AOM is not associated with an increase in severity parameters in subsequent acute mastoiditis admission.
authors.affiliation: From the *Pediatric Clinic, Maccabi Health Services, Tel Aviv, Israel; †Pediatric Infectious Diseases Unit, Haemek Medical Center, Afulah, Israel; ‡Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; §Pediatric Infectious Diseases Unit, Soroka University Medical Center, Beer Sheba, Israel; ¶Pediatric Infectious Diseases Unit, Dana Medical Center, Tel Aviv, Israel; ‖Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; **Pediatric Department, Meyer Children's Hospital, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; ††Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; ‡‡Pediatric Infectious Diseases Unit, Wolfson Medical Center, Holon, Israel; §§Pediatric Infectious Diseases Unit, Carmel Medical Center, Ruth and Bruce Rappaport faculty of medicine, Technion, Haifa, Israel; ¶¶Department of Paediatrics, Ziv Medical Center, Bar Ilan University Faculty of Medicine, Safed, Israel; ‖‖Department of pediatrics, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; and ***Department of pediatrics, Baruch Padeh Medical Center, Poriah, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Zachi
authors.initials: Z
authors.lastname: Grossman
authors.forename: Yoav
authors.initials: Y
authors.lastname: Zehavi
authors.forename: Eugene
authors.initials: E
authors.lastname: Leibovitz
authors.forename: Galia
authors.initials: G
authors.lastname: Grisaru-Soen
authors.forename: Yael
authors.initials: Y
authors.lastname: Shachor Meyouhas
authors.forename: Imad
authors.initials: I
authors.lastname: Kassis
authors.forename: Michal
authors.initials: M
authors.lastname: Stein
authors.forename: Moshe
authors.initials: M
authors.lastname: Ephros
authors.forename: Anthony
authors.initials: A
authors.lastname: Luder
authors.forename: Ellen
authors.initials: E
authors.lastname: Bamberger
authors.forename: Said
authors.initials: S
authors.lastname: Abozaid
authors.forename: Isaac
authors.initials: I
authors.lastname: Srugo
authors.forename: Dan
authors.initials: D
authors.lastname: Miron
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008417:Mastoiditis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D010033:Otitis Media / Q000150:complications* / Q000188:drug therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents