title: Treatment of acute otitis media in general practice: quality variations across countries.
abstract: BACKGROUND
  Recommendations for antibiotic treatment of acute otitis media (AOM) have changed over the years, and today many experts recommend initial observation. However, antibiotic prescribing should be considered in children aged <2 years or if AOM is accompanied by discharging ear.
  
  
  OBJECTIVE
  To investigate the quality of treatment of AOM in general practice and to explore the influence of selected GP and patient characteristics on antibiotic prescribing.
  
  
  METHODS
  During the winter 2008, a prospective registration of patients diagnosed with AOM was conducted in general practice in Lithuania, Kaliningrad, Spain, Argentina, Sweden and Denmark. Some 1175 patients diagnosed with AOM were registered. Information about age and sex of the patient, duration of symptoms (days), temperature >38.5°C, ear discharge and the antibiotic treatment given was recorded.
  
  
  RESULTS
  Danish GPs had the lowest antibiotic prescription rate for AOM [72.7% (95% confidence interval (CI) = 67.0-77.8)] and GPs in Kaliningrad had the highest [97.1% (95% CI = 89.8-99.6)]. Narrow-spectrum penicillin was almost exclusively prescribed in the two Nordic countries, while broad-spectrum penicillins, often in combination with clavulanic acid, were prescribed in the other four countries. Macrolides comprised 5-10% of prescriptions. Antibiotic prescribing was associated with the following characteristics of the patients: symptoms for >3 days, ear discharge and fever.
  
  
  CONCLUSIONS
  The majority of patients with AOM were treated with antibiotics in all six countries, but considerable variations in both prescribing rate and choice of antibiotics were identified.
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark. mplejdrup@health.sdu.dk
authors.forename: Malene Plejdrup
authors.initials: MP
authors.lastname: Hansen
authors.forename: Dorte Ejg
authors.initials: DE
authors.lastname: Jarbol
authors.forename: Bente
authors.initials: B
authors.lastname: Gahrn-Hansen
authors.forename: Rene
authors.initials: R
authors.lastname: Depont Christensen
authors.forename: Anders
authors.initials: A
authors.lastname: Munck
authors.forename: Christina
authors.initials: C
authors.lastname: Ellegaard Trankjær Ryborg
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001118:Argentina; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D058006:General Practice; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012042:Registries
chemical_list: D000900:Anti-Bacterial Agents