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RESEARCH: Salomeh Keyhani, Lawrence C Kleinman, Michael Rothschild, Joseph M Bernstein, Rebecca Anderson, and Mark Chassin Overuse of tympanostomy tubes in New York metropolitan area: evidence from five hospital cohort BMJ 2008; 337: a1607 [Abstract] [Full text]

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Antimicrobial overuse and a high tympanostomy tube placements rate

Vilhjalmur Arason   (12 October 2008)

Antimicrobial overuse and a high tympanostomy tube placements rate 12 October 2008
Vilhjalmur Arason, GP Heilsugaeslan Fjordur, Hafnarfjordur Send response to journal: Re: Antimicrobial overuse and a high tympanostomy tube placements rate	Comparison between communities in studies performed in Iceland 1998 and 2003 1) showed a positive correlation between antimicrobial use for acute otitis media and tympanostomy tube placements among children. A statistically significant association was found between tympanostomy tube placement rate and antimicrobial use for acute otitis media. In the area where antimicrobial use for acute otitis media was lowest in 1998, drug use had further diminished significantly. At the same time, the cumulative prevalence of tympanostomy tube placements among children up to 7 years old had diminished from 26% to 17%. Tube placements had increased significantly, from 35% to 44%, in the area where antimicrobial use for acute otitis media was highest. Parents in the area where antimicrobial consumption was lowest and narrow spectrum antimicrobials were most often used were less likely to be in favour of antimicrobial treatment. The icelandic study supports therefore also a restrictive policy in relation to prescriptions of antibiotics for acute otitis media which may decrease antimicrobial resistance, relapsing infection rate, chronic middle-ear effusion and need for tympanostomy tubes later. It also indicates that well-informed parents predict a restrictive prescription policy 2,3). References: 1) Arason V.A., Sigurdsson J.A, Kristinsson K.G., Getz L, Gudmundsson S. (2005) Otitis media, tympanostomy tube placement and use of antimicrobials. Cross sectional community study repeated after five years. Scand J Prim Healthcare; 23:184-91 2) Arason,V.A. (2006) Use of Antimicrobials and Carriage of Penicillin-Resistant Pneumococci in Children. Repeated cross-sectional studies covering 10 years. PhD thesis University of Iceland. http://www.hirsla.lsh.is/lsh/bitstream/2336/11250/3/use_of_arason_ot_1.pdf 3)http://www.bmj.com/cgi/eletters/337/jul23_3/a437#200478 Competing interests: None declared