Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Mar;56(524):170-5.

Consultations for middle ear disease, antibiotic prescribing and risk factors for reattendance: a case-linked cohort study

Ian Williamson  1 , Sarah Benge, Mark Mullee, Paul Little
Affiliations

Consultations for middle ear disease, antibiotic prescribing and risk factors for reattendance: a case-linked cohort study

Ian Williamson et al. Br J Gen Pract. 2006 Mar.

Abstract

Background: Otitis media is the most common reason for children to receive antibiotics, but there is no evidence about the effect of prescribing on reattendance.

Aim: To evaluate the changing workload of middle ear disease in general practice, and the impact on surgery reattendance of prescribing antibiotics at first attendance.

Design of study: A case-linked cohort analysis for antibiotic prescribing versus no prescribing at first consultation event.

Setting: Two hundred and ninety-one practices spread throughout the UK recording for the General Practice Research Database (GPRD) and incorporating individual patient data records for 2,265,574 patients.

Method: All middle ear disease coded events that can be classed within acute otitis media (AOM) or glue ear sub-categories (and excluding chronic suppurative otitis media) were selected for analysis when the first event was from 1991-2001. The effect of antibiotic prescription on the risk of reattendance using Cox proportional hazards regression was analysed.

Results: Total consultations for AOM have fallen markedly over this decade, and glue ear consultations have risen but by a much smaller extent (26,000 decrease versus 4000 increase in consultations per year), which makes relabelling an unlikely explanation of the fall in AOM consultations. In the 2-10 years age range, consultations for AOM fell from 105.3 to 34.7 per 1000 per year, with glue ear consultations unaltered (15.2 to 16.7 per 1000 per year). Antibiotic prescribing for AOM has stayed remarkably constant (80-84% of consultations), but antibiotic prescribing for glue ear has risen sharply (13 to 62%). Prescribing antibiotics increased the risk of reattendance for AOM (hazard ratio [HR] = 1.09, 95% confidence interval [CI] = 1.07 to 1.10) and has reduced the risk of reattendance for glue ear (HR = 0.92, 95% CI = 0.88 to 0.96).

Conclusion: Prescribing antibiotics for AOM probably increased reattendance, but the opposite effect has been noted for glue ear, which suggests a treatment effect of antibiotics in glue ear. Further research is needed to clarify whether this possible benefit is worth the known harms, and if so in which subgroups of children.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Numbers of consultations by year
Figure 2
Figure 2
Percentage of acute otitis media/otitis media with effusion cases receiving antibiotics by year
See this image and copyright information in PMC

Comment in

References

    1. Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004;113:1451–1465. - PubMed
    1. Stool SE, Berg AO, Berman S, et al. Otitis media with effusion in children. Guideline Technical Report, Number 12. Rockville MD: AHCPR; 1994. (95-0621)
    1. Haggard M, Hughes E. Objectives values and methods of screening childrens' hearing — a review of the literature. London: HMSO; 1991.
    1. Fergie N, Bayston R, Pearson JP, Birchall JP. Is otitis media with effusion a biofilm infection? Clin Otolaryngol. 2004;29:38–46. - PubMed
    1. Select Committee on Science and Technology. Resistance to antibiotics and other antimicrobial agents. 7th Report. London: HMSO; 1998. (HL 81-I)

Publication types

MeSH terms

Substances