title: Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline.
abstract: OBJECTIVE
  Observation without initial antibiotic therapy was accepted as an option for acute otitis media (AOM) management in the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline. The guideline also recommended amoxicillin as the first-line treatment for most children, and analgesic treatment to reduce pain if it was present. Our objective was to compare the management of AOM after publication of the 2004 guideline.
  
  
  METHODS
  We analyzed the National Ambulatory Medical Care Survey, 2002-2006 (N = 1114), which occurred in US physicians' offices. The patients were children aged 6 months to 12 years who were diagnosed with AOM. The time comparisons were the 30-month periods before and after the guideline. The main outcome was the encounter rate at which no antibiotic-prescribing was reported. Secondary outcomes were the identification of factors associated with encounters at which no antibiotic-prescribing was reported and antibiotic- and analgesic-prescribing rates.
  
  
  RESULTS
  The rate of AOM encounters at which no antibiotic-prescribing was reported did not change after guideline publication (11%-16%; P = .103). Independent predictors of an encounter at which no antibiotic-prescribing was reported were the absence of ear pain, absence of reported fever, and receipt of an analgesic prescription. After guideline publication, the rate of amoxicillin-prescribing increased (40%-49%; P = .039), the rate of amoxicillin/clavulanate-prescribing decreased (23%-16%; P = .043), the rate of cefdinir-prescribing increased (7%-14%; P = .004), and the rate of analgesic-prescribing increased (14%-24%; P = .038).
  
  
  CONCLUSIONS
  Although management of AOM without antibiotics has not increased after the publication of the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline, children who did not receive antibiotics were more likely to have mild infections. In accordance with the guideline, the prescribing of amoxicillin and analgesics has increased. Contrary to the guideline, the prescribing of amoxicillin/clavulanate has decreased, whereas the prescribing of cefdinir has increased.
authors.affiliation: Lancaster General Hospital, Lancaster General Research Institute, 555 N Duke St, Lancaster, PA 17604, USA. ascoco@lancastergeneral.org
authors.forename: Andrew
authors.initials: A
authors.lastname: Coco
authors.forename: Louis
authors.initials: L
authors.lastname: Vernacchio
authors.forename: Michael
authors.initials: M
authors.lastname: Horst
authors.forename: Angela
authors.initials: A
authors.lastname: Anderson
mesh_terms: D000208:Acute Disease; D000658:Amoxicillin / Q000008:administration & dosage; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010033:Otitis Media / Q000188:drug therapy*; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin