Acute otitis media in children--there are guidelines but are they followed?
OBJECTIVE
To determine whether guidelines relating to the diagnosis and treatment of acute otitis media (AOM) in children are followed in a tertiary paediatric emergency department (ED).


METHODS
A literature search was undertaken to identify national and international guidelines relating to the diagnosis and management of AOM in children. The guidelines were assessed for their applicability to UK practice. A retrospective case note audit was undertaken. Children presenting to the ED with a discharge diagnosis of AOM over a two month period were identified from the ED computer discharge system. The notes were analysed for compliance with the identified guidelines.


RESULTS
50 children were identified (age range three months to 11 years). Eighty-six per cent of children received antibiotics. Fifty-two per cent of children had documented signs of AOM. Twenty-five of these children received antibiotics (22 in accordance with guidelines, three not in accordance with guidelines, antibiotic not documented in one case). Thirty-nine per cent of children received antibiotics inappropriately. In all cases, the antibiotic dosage was below the dose recommended in all guidelines.


CONCLUSIONS
There is poor compliance with national (and international) guidelines for the management of AOM in this ED. National guidelines must be introduced into the department by direct teaching at senior house officer and middle grade level, a re-audit must be carried out and regular reviews of the notes of patients diagnosed with AOM must be undertaken to ensure compliance with guidelines is maintained.
Woolley
S L
SL
Emergency Department, Bristol Royal Infirmary/Bristol Children's Hospital, Bristol, UK. woolley_s@hotmail.com
Smith
D R K
DR
D000208:Acute Disease; D000658:Amoxicillin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008485:Medical Audit; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom
D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin