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. 2020 Mar 26;70(693):e255-e263.
doi: 10.3399/bjgp20X708821. Print 2020 Apr.

Antibiotic use and serious complications following acute otitis media and acute sinusitis: a retrospective cohort study

Rebecca Cushen  1 , Nick A Francis  2
Affiliations

Antibiotic use and serious complications following acute otitis media and acute sinusitis: a retrospective cohort study

Rebecca Cushen et al. Br J Gen Pract. .

Abstract

Background: Most people with acute otitis media (AOM) and acute sinusitis (AS) do not benefit from antibiotics, and GPs are under increasing pressure to reduce antibiotic prescribing. Concern about the risk of complications can drive unnecessary prescribing.

Aim: To describe the incidence of serious complications following AOM and AS, and to determine whether antibiotics are protective.

Design and setting: This was a retrospective cohort study using the Clinical Practice Research Datalink database to identify patients diagnosed in general practice with AOM or AS between 1 January 1982 and 31 December 2012.

Method: The incidence of brain abscess and acute mastoiditis following AOM, and of brain abscess and orbital cellulitis following AS, were calculated, as was the association between antibiotics and the development of these complications and numbers needed to treat (NNT).

Results: The incidence of brain abscess and acute mastoiditis following AOM were 0.03 (95% confidence interval [CI] = 0.01 to 0.20) and 5.62 (95% CI = 4.81 to 6.56) per 10 000 AOM episodes, respectively. The incidence of brain abscess and orbital cellulitis following AS was 0.11 (95% CI = 0.05 to 0.26) and 1.50 (95% CI = 1.17 to 1.90) per 10 000 AS episodes, respectively. Antibiotic prescription for AOM was associated with lower odds of developing acute mastoiditis (odds ratio [OR] 0.54; 95% CI = 0.37 to 0.79); NNT to prevent one case was 2181 (95% CI = 1196 to 5709). Antibiotic prescribing for AS was associated with lower odds of subsequent brain abscess (OR 0.12; 95% CI = 0.02 to 0.70); NNT to prevent one case was 19 988 (95% CI = 4951 to 167 099). No significant association between antibiotic prescription and development of orbital cellulitis following AS were found (OR 0.56; 95% CI = 0.27 to 1.12).

Conclusion: Serious complications following AOM and AS are rare. Antibiotics are associated with lower odds of developing complications, but the NNT are large.

Keywords: acute otitis media; acute sinusitis; antibiotics; complications; general practice; retrospective studies.

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Figures

Figure 1.
Figure 1.
CONSORT flow diagram for acute otitis media (AOM). CONSORT = Consolidated Standards of Reporting Trials. CPRD = Clinical Practice Research Datalink.
Figure 2.
Figure 2.
CONSORT flow diagram for acute sinusitis (AS). CONSORT = Consolidated Standards of Reporting Trials. CPRD = Clinical Practice Research Datalink.
See this image and copyright information in PMC

References

    1. World Health Organization The evolving threat of antimicrobial resistance Options for action. 2012 http://whqlibdoc.who.int/publications/2012/9789241503181_eng.pdf (accessed 20 Feb 2020).
    1. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. 2016 The Review on Antimicrobial Resistance, https://amr-review.org/sites/default/files/160525_Final%20paper_with%20c... (accessed 20 Feb 2020).
    1. Public Health England English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) Report 2018. 2018 https://webarchive.nationalarchives.gov.uk/20191003132022/ https://www.gov.uk/government/publications/english-surveillance-programm... (accessed 20 Feb 2020).
    1. NHS, National Institute for Health and Care Excellence . Respiratory tract infections — antibiotic prescribing Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care CG69. London: NICE; 2008. https://www.nice.org.uk/guidance/cg69/evidence/full-guideline-pdf-196853293 (accessed 20 Feb 2020). - PubMed
    1. Gulliford MC, Dregan A, Moore MV, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open. 2014;4(10):e006245. - PMC - PubMed

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