Have the characteristics of acute mastoiditis in children changed in the post-heptavalent pneumococcal conjugate vaccine (PCV7) era?
Background: With the advent of antibiotics, the incidence of acute mastoiditis, a complication of acute otitis media (AOM), has decreased. In recent years, however, there have been reports of an increase in the frequency of acute mastoiditis, which remains a significant, possibly life-threatening complication of AOM. It is not known whether the PCV7 has affected incidence, presentation, bacteriology or management of acute mastoiditis.
Explore this issue:May 2011
Study design: A retrospective case series study at an urban tertiary care children’s hospital.
Setting: Children’s National Medical Center, Department of Otolaryngology, Washington, D.C.
Synopsis: Of 96 children admitted between July 1996 and December 2002, there was a 53 percent increase in admission for acute mastoiditis in the post-PCV7 era. The pre- and post-PCV7 groups had similar demographic features, presenting history, signs and symptoms, laboratory results and medical management. CT studies in the two groups were similar, and Streptococcus pneumoniae was the most common pathogen in each group.
The post-PCV7 group had more advanced disease but shorter hospital stays, despite undergoing more extensive surgery. The authors said it is likely that most of the post-PCV7 group had immunity against the pneumococcal serotypes contained in PCV7.
Bottom line: Despite the success of PCV7 in reducing other invasive S. pneumoniae diseases in children, such as meningitis and bacteremia, the rise in resistance indicates that a combination of antibiotics rather than a single agent should be used in the treatment of acute mastoiditis.
Citation: Choi SS, Langer L. Pediatric acute mastoiditis in the post-pneumococcal conjugate vaccine era. Laryngoscope. 2011;121(5):1072-1080.
—Reviewed by Sue Pondrom