title: Comparison of two approaches to observation therapy for acute otitis media in the emergency department.
abstract: OBJECTIVE
  This study compared parental adherence to delayed antibiotic therapy for acute otitis media with and without a written prescription in a pediatric emergency department.
  
  
  METHODS
  Children aged 2 to 12 years who met criteria for delayed antibiotic treatment were randomly assigned to observation therapy with or without a prescription. Patients randomly assigned to observation therapy without prescription were instructed to seek follow-up care if symptoms persisted for 2 to 3 days. Patients assigned to observation therapy with a prescription were discharged with an antibiotic prescription, and instructed to fill it if their child's symptoms persisted 2 to 3 days. A research assistant who was blinded to group assignment called parents 7 to 10 days after the visit to assess adherence to observation therapy.
  
  
  RESULTS
  Of 117 children assigned to the observation therapy group, 100 completed follow-up; of 115 assigned to the observation therapy with a prescription group, 106 completed follow-up. In the observation therapy group, 87 parents reported no antibiotic use within the 3-day observation period compared with 66 parents in the prescription group. During the entire study period, 81% of the observation therapy group reported no use of antibiotics compared with 53% in the prescription group. These groups did not differ in satisfaction with the visit; 91% and 95% were very or extremely satisfied, respectively. No complications were reported.
  
  
  CONCLUSIONS
  Observation therapy with and without a prescription were both well accepted by parents of children diagnosed with acute otitis media in an urban pediatric emergency department. Adherence to delayed antibiotic therapy was better for those not offered a prescription. These data suggest that, in the pediatric emergency department setting, observation therapy reduces antibiotic use without compromising satisfaction with the visit.
authors.affiliation: Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. jenniferhchao@hotmail.com
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Chao
authors.forename: Sergey
authors.initials: S
authors.lastname: Kunkov
authors.forename: Lilia B
authors.initials: LB
authors.lastname: Reyes
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lichten
authors.forename: Ellen F
authors.initials: EF
authors.lastname: Crain
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D010033:Otitis Media / Q000188:drug therapy / Q000628:therapy*; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction
chemical_list: D000900:Anti-Bacterial Agents