title: Adherence to therapeutic guidelines for acute otitis media in children younger than 2 years.
abstract: OBJECTIVE
  to analyze adherence to therapeutic guidelines for AOM.
  
  
  METHODS
  Descriptive retrospective study of community primary care providers in southern Israel. Study population (n = 590) included all children aged 0-48 months diagnosed with AOM in PED during the year 2000 who had a referral letter from a community physician and an AOM diagnosis confirmed by tympanocentesis. AOM antibiotic treatment was considered appropriate when in accord with CDC and local therapeutic guidelines.
  
  
  RESULTS
  Referral letter data allowing characterization of AOM by category were available in 471 (79.8%) children, 320 (68%) with simple AOM and 151(32%) with complicated AOM. AOM diagnosis made by the primary care physician was in accord with PED diagnosis in 365/590 (62%) patients. Three hundred and fifty-five (60.2%) patients did not receive antibiotics in the community. Of 365 (62%) children diagnosed with AOM in the community, 235 (64.4%) were treated with antibiotics prior to arrival to PED. Amoxicillin was prescribed to 109 (46.4%), cefuroxime axetil to 48 (20.4%), amoxicillin/clavulanate to 31 (13.2%) and i.m. ceftriaxone to 20 (8.5%) of the patients. Eighty-three (25.9%) patients with simple AOM were treated with antibiotics in the community and only 46 (55.4%) received amoxicillin according to the therapeutic guidelines. Eighty-one (53.6%) patients with complicated AOM were treated with antibiotics in the community and only 41 (50.6%) of them received antibiotics according to AOM therapeutic guidelines. More antibiotics were prescribed in the community to patients with complicated AOM than to patients with simple AOM (81/151, 53.6% versus 83/320, 25.9%, respectively, p < 0.001). Adherence to therapeutic guidelines was similar between the simple and the complicated AOM groups (46/83, 55.4% versus 41/81, 50.6%, respectively, p = 0.5).
  
  
  CONCLUSIONS
  We found partial adherence to AOM therapeutic guidelines among primary care providers in the community in Southern Israel.
authors.affiliation: Department of Health Care Policy and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel. reuvenil@bgu.ac.il
authors.forename: Haim
authors.initials: H
authors.lastname: Reuveni
authors.forename: Elad
authors.initials: E
authors.lastname: Asher
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
authors.forename: Joseph
authors.initials: J
authors.lastname: Press
authors.forename: Natalya
authors.initials: N
authors.lastname: Bilenko
authors.forename: Eugene
authors.initials: E
authors.lastname: Leibovitz
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel; D008297:Male; D010033:Otitis Media / Q000175:diagnosis / Q000628:therapy*; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents