title: Pharmacological treatment of acute otitis media in children. A comparison among seven locations: Tenerife, Barcelona and Valencia (Spain), Toulouse (France), Smolensk (Russia), Bratislava (Slovakia) and Sofia (Bulgaria).
abstract: OBJECTIVE
  To describe patterns observed in the treatment of acute otitis media (AOM) in several locations of five countries.
  
  
  METHODS
  Cross-sectional, descriptive study. Random sample of 12,264 paediatric outpatients seen by paediatricians or general practitioners (GPs). Data on patient demographics, diagnoses and treatment were collected. Diagnoses were coded by ICD-9 and drugs by ATC classification. Patients diagnosed with AOM (ICD-9 codes: 381 and 382) were selected for analysis.
  
  
  RESULTS
  Cases of AOM (873) accounted for 7.1% of the sample. There is a clear variation in the percentage of children diagnosed with AOM and treated with antibiotics in the different locations, antibiotic prescriptions being higher in Barcelona (93% of children), and lowest in Smolensk (56.4 % of children were treated without antibiotics). The antibiotics used varied widely: ampicillin use is almost limited to Smolensk (26.7%) and Bratislava (13.8%), whereas amoxicillin plus clavulanic acid is the choice in Toulouse (33.8%), Valencia (30.2%) and Barcelona (28.9%), and cephalosporins are more frequently prescribed in Tenerife (51.7%). Finally, macrolides are used in Barcelona (18.3%), Valencia (17.5%) and Tenerife (13.6%), but not prescribed in Toulouse or Sofia. Prescriptions of anti-inflammatory drugs were only relevant in Valencia (31.7%), Tenerife (27.2%) and Toulouse (17.4%) and of otological preparations in Sofia, where almost each child received ear drops (91.9%). Nasal preparations are commonly used only in Sofia (41.9%), Bratislava (65.5%) and Smolensk (68.6%).
  
  
  CONCLUSIONS
  Despite the general agreement of most guidelines, wide differences in the treatment of uncomplicated AOM in children are observed. Non-antibiotic therapy for AOM and the use of first-choice antibiotics should be more actively encouraged in the primary care centres. Studies to measure prevailing rates of antibiotic resistance in these populations are needed.
authors.affiliation: Department of Clinical Pharmacology, School of Medicine, University of La Laguna, 38071 La Laguna, Tenerife, Spain, esanz@ull.es
authors.forename: E
authors.initials: E
authors.lastname: Sanz
authors.forename: M A
authors.initials: MA
authors.lastname: Hernández
authors.forename: M
authors.initials: M
authors.lastname: Kumari
authors.forename: S
authors.initials: S
authors.lastname: Ratchina
authors.forename: L
authors.initials: L
authors.lastname: Stratchounsky
authors.forename: M A
authors.initials: MA
authors.lastname: Peiré
authors.forename: M
authors.initials: M
authors.lastname: Lapeyre-Mestre
authors.forename: B
authors.initials: B
authors.lastname: Horen
authors.forename: M
authors.initials: M
authors.lastname: Kriska
authors.forename: H
authors.initials: H
authors.lastname: Krajnakova
authors.forename: H
authors.initials: H
authors.lastname: Momcheva
authors.forename: D
authors.initials: D
authors.lastname: Encheva
authors.forename: I
authors.initials: I
authors.lastname: Martínez-Mir
authors.forename: V
authors.initials: V
authors.lastname: Palop
mesh_terms: D000208:Acute Disease; D000287:Administration, Topical; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D005060:Europe / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D006801:Humans; D038801:International Classification of Diseases; D018942:Macrolides / Q000008:administration & dosage / Q000627:therapeutic use; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D010818:Practice Patterns, Physicians'
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D002511:Cephalosporins; D018942:Macrolides; D019980:Amoxicillin-Potassium Clavulanate Combination