Delayed prescription may reduce the use of antibiotics for acute otitis media: a prospective observational study in primary care.
OBJECTIVE
To evaluate the applicability and the effectiveness of practice guidelines based on a wait-and-see strategy for children with acute otitis media (AOM).


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


METHODS
Prospective observational study.


METHODS
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.
Department of Pediatrics and Epidemiology Unit, Institute of Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
Federico
F
Marchetti
Luca
L
Ronfani
Sergio Conti
SC
Nibali
Giorgio
G
Tamburlini
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019370:Observation; D010033:Otitis Media / Q000188:drug therapy*; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents