Tympanostomy tube placements, sociodemographic factors and parental expectations for management of acute otitis media in Iceland.
BACKGROUND
Widespread antimicrobial use is a risk factor for development of antimicrobial resistance. Antimicrobial treatment of acute otitis media (AOM) may not always be necessary. Little is known about the influence of parental expectations on physicians' decision-making in relation to treatment of AOM. Evidence is insufficient as to whether tympanostomy tube placement reduces antibiotic consumption.


METHODS
We randomly selected 1,030 children 1 to 6 years old living in 4 geographic areas in Iceland to be invited to participate in the study. Information about sociodemographic factors, antimicrobial prescriptions and their indications during the preceding 12 months, tympanostomy tube placements and parental views on antimicrobial use and bacterial resistance were obtained from a questionnaire completed by the parents and medical records.


RESULTS
The incidence of AOM episodes resulting in antimicrobial prescription for 804 children recruited into the study was 0.7 (95% confidence interval, 0.6 to 0.8) per child per year, highest among children age 1 year, i.e. 1.8 prescriptions (95% confidence interval, 1.4 to 2.2). The cumulative incidence of tympanostomy tube placements was approximately 30%. Antimicrobial use during the preceding 8 weeks for children with and without tubes did not differ (P = 0.36). Fifteen percent of children with tubes had received antimicrobials during the preceding 8 weeks at last once for AOM compared with 14% of those without tubes (P = 0.97). Parents in the area where antimicrobial consumption was lowest were less likely to accept antimicrobial treatment than parents in the other areas (P = 0.005). Parents of children who had previously received antimicrobials for AOM were more likely to accept antimicrobials (P = 0.04).


CONCLUSIONS
Parental expectations to antimicrobial treatment and awareness about resistance development appear to influence treatment strategies for AOM. The high rate of tympanostomy tube placement in preschool children does not result in reduced antimicrobial consumption.
Arason
Vilhjalmur A
VA
Department of Family Medicine, Univeristy of Iceland, Solvangur, Hafnarfjordur, Iceland. vaa@hgsolvangur.is
Sigurdsson
Johann A
JA
Kristinsson
Karl G
KG
Gudmundsson
Sigurdur
S
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016017:Odds Ratio; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D010290:Parents; D017060:Patient Satisfaction; D011336:Probability; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents