Meningitis too easily dismissed?
The Canadian Pediatric Society recommends watching and waiting before using antibiotics in kids with otitis media. The author of their position statement said that 1,000 children would have to be treated to prevent one case of meningitis, brain abscess or mastoiditis, characterizing these as “rare, rare” complications. Having watched the horror of many cases of meningitis in the past, I question the dismissal of a 1 in 1,000 rate as “rare,” given the morbidity and mortality of these sequelae. Would you not treat your own child knowing there was a 1/1,000 risk? Please comment. Steve Strigler, MD, Toronto, ON
As antibiotic resistance rates continue to rise, we’re becoming more diligent at prescribing them. The CPS recommends watchful waiting for the over 2 year age group but not for those younger. I believe the risk of serious complications is much lower in the older age group, especially since the advent of newer vaccines against meningitis, and therefore I tell parents a to treat the child symptomatically and wait 24 hours with an otitis media. I tell the parents to return if symptoms such as pain or fever continue. I still believe we’re over-diagnosing ear infections. A red ear in an otherwise well child not showing signs of pain is unlikely to be an ear infection.