International perspectives on management of acute otitis media: a qualitative review.
BACKGROUND
Current opinions regarding the management of acute otitis media (AOM) in children vary across Western countries. With antibiotic resistance rising and more evidence regarding the limited clinical efficacy of antibiotics becoming available, interest in managing AOM other than with antibiotics is renewed.


OBJECTIVE
To compare international rates of antibiotic prescription and surgery for AOM. To provide current evidence regarding the efficacy of various treatment options for AOM and their potential complications.


METHODS
Qualitative (narrative) review.


RESULTS
The percentage of patients given antibiotics for AOM varies from 31% in The Netherlands to more than 90% in most other Western countries. The 1998 prevalence of penicillin-resistant S. pneumoniae strains, on the other hand, ranges from 3% in The Netherlands to 53% in France. The surgical rate for tympanostomy tubes varies from 2 per 1000 children per year in the United Kingdom to 20 per 1000 in The Netherlands. The benefit of both antibiotic and surgical therapy in AOM appears to be limited, with numbers needed to treat ranging from 8 to 25 for antibiotic therapy, depending on the definition of outcome.


CONCLUSIONS
International rates of antibiotic prescription and surgery for AOM vary strongly, which can be explained largely by the lack of uniform evidence-based guidelines. International debates with the aim of overcoming cultural differences regarding the management of otitis media, and of reaching agreement on guidelines on the basis of current evidence are necessary.
Schilder
Anne G M
AG
Department of Otorhinolaryngology (KE 04.140.5), Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands. a.schilder@wkz.azu.nl
Lok
Willeke
W
Rovers
Maroeska M
MM
D000208:Acute Disease; D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D019317:Evidence-Based Medicine; D006801:Humans; D008417:Mastoiditis / Q000453:epidemiology / Q000628:therapy; D008876:Middle Ear Ventilation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D010033:Otitis Media / Q000453:epidemiology* / Q000628:therapy; D010403:Penicillin Resistance; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents