According to research published in Pediatrics, the use of antibiotics in children with acute otitis media as prophylaxis against mastoiditis does not appear to be a productive strategy.

Researchers retrospectively collected information from the UK General Practice Research Database to determine whether the incidence of mastoiditis has increased in association with the decline in the prescription of antibiotics to children by primary care physicians in the UK.  A total of 2,622,348 children aged 3 months to 15 years in the period 1990-2006 were identified in the database; of these 854 had mastoiditis.  The risk of mastoiditis after otitis media was calculated as 1.8 per 10,000 episodes (139 of 792,623) after antibiotics compared to 3.8 per 10,000 (149 of 389,649) without antibiotics.  The incidence of mastoiditis remained stable over the study period (around 1.2 per 10,000 child-years).  

Based on these figures, GPs would need to treat 4,831 otitis media episodes with antibiotics to prevent one child from developing mastoiditis.  The authors conclude that although antibiotics halve the risk of mastoiditis, “the high number of episodes needing treatment to prevent one case precludes the treatment of otitis media as a strategy for preventing mastoiditis”. An extra 255 cases of childhood mastoiditis would occur per year in the UK if antibiotics were no longer prescribed for otitis media, but there would be 738,775 fewer antibiotic prescriptions and this could have important public health consequences in terms of antibiotic resistance.