Stikilbólga hjá börnum á Íslandi

Abstract

INTRODUCTION: Mastoiditis is an infection in the mastoid process and is a complication of otitis media. Studies have revealed that the incidence might be increasing with altered antibiotic usage. The aim of the current study was to describe the epidemiology, clinical symptoms and treatment of mastoiditis in Iceland during the last two decades with special emphasis on children and to study possible correlations between antibiotic use and incidence of mastoiditis. PATIENTS AND METHODS: Information on patients diagnosed with mastoiditis during the period 1984-2002 at The Children's Hospital Iceland, The Department of Paediatrics, Landakoti and Landspitali--University Hospital Iceland was gathered and clinical data were recorded from patients records of children diagnosed with mastoiditis during 1999-2002. Information on antibiotic use during the years 1989-2002 was obtained from the Ministry of Health in Iceland. RESULTS: Eighty-four patients were diagnosed with mastoiditis during the period 1984-2002. Of those, 52 (62%) were children less than 18 years of age. The mean age of those children was 2 years and 8 months. Boys were 58%. Twenty six (50%) of the children were less than three years old. During the years 1999-2002, a total of 28 children were diagnosed; the mean age was 2 years and 2 months. Fifteen children (54%) sought medical attention within a week prior to admission to hospital and had been diagnosed with otitis media. Eleven children (73%) were appropriately treated with antibiotics prior to the diagnosis of mastoiditis but four (27%) received no antibiotics. During the period 1989-2002, a statistically significant correlation was detected between decreased antibiotic use among children and increasing incidence of mastoiditis (r=-0.68; p=0.007). DISCUSSION: Following changes in guidelines for antibiotic prescriptions for otitis media in Iceland during the nineties, antibiotic use in children decreased at the same time as the incidence for mastoiditis increased. It is uncertain, however, if a causal relationship exists. It is important to diagnose and appropriately treat otitis media, while staying alert for serious complications, especially in young children.

Inngangur: Stikilbólga er sýking í stikilholrýmum gagnaugabeins og fylgikvilli miðeyrnabólgu. Erlendar rannsóknir benda til að síðustu ár hafi nýgengi aukist með breyttri notkun sýklalyfja við miðeyrnabólgu. Tilgangur rannsóknarinnar var að skoða faraldsfræði, einkenni og meðferð stikilbólgu á Íslandi síðustu 20 ár með sérstaka áherslu á börn með stikilbólgu, ásamt fylgni sýklalyfjanotkunar við nýgengi stikilbólgu. Sjúklingar og aðferðir: Upplýsingar um þá sem greindust með stikilbólgu á árunum 1984-2002 á Barnaspítala Hringsins, Landakoti og Landspítala (áður Borgarspítali og Sjúkrahús Reykjavíkur) voru skráðar og sjúkraskrár þeirra sem greindust á árunum 1999-2002 voru skoðaðar. Hjá heilbrigðisráðuneytinu fengust upplýsingar um sýklalyfjanotkun á Íslandi á tímabilinu 1989-2002. Niðurstöður: Alls greindust 84 með stikilbólgu á árunum 1984-2002, þar af 52 börn (62%). Miðaldur þeirra var 2 ár og 8 mánuðir. Drengir voru 58%. Tuttugu og sex (50%) börn voru yngri en 3 ára. Á árunum 1999-2002 greindust 28 börn, miðaldur var 2 ár og 2 mánuðir. Fimmtán börn (54%) leituðu til læknis innan viku fyrir innlögn og greindust með miðeyrnabólgu. Ellefu börn (73%) fengu viðeigandi sýklalyf en fjögur (27%) fengu ekki meðferð fyrir innlögn. Á tímabilinu 1989-2002 var marktæk fylgni á milli minnkandi notkunar sýklalyfja hjá börnum og vaxandi nýgengis stikilbólgu (r =-0,68; p = 0,007). Ályktanir: Í kjölfar breyttra ráðlegginga um sýklalyfjanotkun við miðeyrnabólgu á Íslandi sem birtar voru upp úr 1990 dró úr notkun sýklalyfja hjá börnum og nýgengi stikilbólgu jókst en óvíst er hvort um beint orsakasamhengi er að ræða. Mikilvægt er að greina miðeyrnabólgu og meðhöndla á réttan hátt, og vera vakandi fyrir alvarlegum fylgikvillum, einkum hjá ungum börnum.