Delayed prescription may reduce the use of antibiotics for acute otitis media: a prospective observational study in primary care

Abstract

Objectives: To evaluate the applicability and the effectiveness of practice guidelines based on a wait-and-see strategy for children with acute otitis media (AOM).

Population: Children from 1 to 14 years old having AOM who were referred to primary care pediatric practices.

Study design: Prospective observational study.

Main outcome measure: Proportion of children having a diagnosis of AOM and eligible for symptomatic treatment who, at 72 hours from enrollment, recovered from their symptoms (fever and earache) without receiving antibiotic treatment.

Results: One hundred sixty-nine pediatricians participated in the study and enrolled 1672 children. One thousand two hundred seventy-seven children were included in the analysis. One hundred seventy-eight children received antibiotic treatment at first contact according to the practice guidelines criteria (presence of otorrhea or recurrent AOM). Of the 1099 children who were eligible for symptomatic treatment only, 743 (67.6%) recovered without antibiotic treatment at 3 days and 716 (65.1%) at 30 days. No complications were observed. Coexistence of a high fever (temperature > or = 38.4 degrees C) and red and bulging tympanic membrane as well as male sex were significantly associated with antibiotic use.

Conclusions: Practice guidelines based on a wait-and-see strategy for children with AOM are applicable and effective in primary care. This strategy was able to avoid the administration of antibiotic treatment in 2 of 3 children.