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To the Editor: Dr Paradise¹ did not mention a randomized controlled trial² that found that immediate antibiotic use reduced the duration of AOM symptoms, but the benefit occurred mainly after the first 24 hours, when pain or distress was diminishing anyway.

The use of a delayed-antibiotic strategy in the Netherlands (with closer monitoring in children younger than 2 years) is associated with a very low rate of antibiotic use and with decreased resistance among causative organisms.³ Restricted use of antibiotics for AOM is associated with an increase of no more than 2 additional cases of mastoiditis per 100 000 children per year.⁴ Furthermore, the increased incidence of acute mastoiditis could also be related to penicillin-resistant organisms.⁵

Luca Mascitelli, MD
Casa di Cura "Città di Udine"
Udine, Italy

Francesca Pezzetta, MD
Ospedale San Michele
Gemona del Friuli, Italy

1. Paradise JL. A 15-month-old child with recurrent otitis media. JAMA. 2002;288:2589-2598. FREE FULL TEXT 2. Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavy J. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ. 2001;322:336-342. FREE FULL TEXT 3. Froom J, Culpepper L, Jacobs M, et al. Antimicrobials for acute otitis media? a review from the International Primary Care Network. BMJ. 1997;315:98-102. FREE FULL TEXT 4. Van Zuijlen DA, Schilder AG, Van Balen FA, Hoes AW. National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media? Pediatr Infect Dis J. 2001;20:140-144. WEB OF SCIENCE | PUBMED 5. Antonelli PJ, Dhanani N, Giannoni CM, Kubilis PS. Impact of resistant pneumococcus on rates of acute mastoiditis. Otolaryngol Head Neck Surg. 1999;121:190-194. FULL TEXT | WEB OF SCIENCE | PUBMED

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:1383.

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