title: Impact of 2011 French guidelines on antibiotic prescription for acute otitis media in infants.
abstract: OBJECTIVE
  In 2011, new guidelines on antibiotic prescription for acute otitis media (AOM) were published in France to decrease the use of third generation cephalosporins that promote the carriage of extended-spectrum beta-lactamase producing Escherichia coli. Our objective was to assess the impact of the 2011 French recommendations on the type of antibiotics prescribed for AOM.
  
  
  METHODS
  Fourteen thousand six hundred and sixty-one children, 6 to 24 months of age, presenting with AOM were included in 2 studies, between November 1, 2009 and October 31, 2012. The first one was conducted with the support of 62 private practice pediatricians; the second one was conducted in 7 pediatric emergency departments. Three periods of 1 year each were defined.
  
  
  RESULTS
  Antibiotics were prescribed in 12,471 (85.1%) of cases of AOM during the study period. Amoxicillin prescriptions was multiplied by 25, between the first year (2.6%) and the last year (66.1%). Conversely, prescriptions of cefpodoxime proxetil and amoxicillin-clavulanic acid decreased from 33.6% and 62.0% in the first year to 5.2% and 27.7% in the last year, respectively. This trend was observed in both private practices and in the pediatric emergency departments.
  
  
  CONCLUSIONS
  Amoxicillin became the most frequently prescribed antibiotic for AOM in 2012, complying with the 2011 French guidelines, while the proportion of prescribed broad-spectrum antibiotics decreased. Our study highlights the importance of guidelines to decrease the prescription of broad-spectrum antibiotics, a crucial factor in the prevention of antibiotic resistance.
authors.affiliation: Association clinique et thérapeutique infantile du Val-de-Marne (ACTIV), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; CRC, centre hospitalier intercommunal de Créteil, 94000 Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Levy
authors.affiliation: Service d'accueil des urgences pédiatriques, université Paris-Diderot, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Pereira
authors.affiliation: Service des urgences pédiatriques, université Pierre-et-Marie-Curie, hôpital Armand-Trousseau, AP-HP, 75012 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Guedj
authors.affiliation: Association française de pédiatrie ambulatoire (AFPA), 30400 Villeneuve-les-Avignons, France.
authors.forename: C
authors.initials: C
authors.lastname: Abt-Nord
authors.affiliation: Association française de pédiatrie ambulatoire (AFPA), 30400 Villeneuve-les-Avignons, France.
authors.forename: N Baudino
authors.initials: NB
authors.lastname: Gelbert
authors.affiliation: Association clinique et thérapeutique infantile du Val-de-Marne (ACTIV), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; CRC, centre hospitalier intercommunal de Créteil, 94000 Créteil, France.
authors.forename: R
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Unité d'épidémiologie clinique Inserm CIE 5, université Paris-Diderot, hôpital Robert-Debré, AP-HP, 75019 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Alberti
authors.affiliation: Service de pédiatrie, université Paris-Sud, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France; Inserm, U1018, équipe reproduction et développement de l'enfant, centre de recherche en épidémiologie et santé des populations (CESP), 94807 Villejuif, France.
authors.forename: V
authors.initials: V
authors.lastname: Gajdos
authors.affiliation: Service d'accueil des urgences pédiatriques, université Paris-Diderot, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Inserm, U1018, équipe reproduction et développement de l'enfant, centre de recherche en épidémiologie et santé des populations (CESP), 94807 Villejuif, France. Electronic address: francois.angoulvant@rdb.aphp.fr.
authors.forename: F
authors.initials: F
authors.lastname: Angoulvant
mesh_terms: D000208:Acute Disease; D000658:Amoxicillin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015296:Ceftizoxime / Q000031:analogs & derivatives / Q000627:therapeutic use; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005602:France; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data; D007223:Infant; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D010033:Otitis Media / Q000188:drug therapy*; D010372:Pediatrics / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D011331:Private Practice / Q000706:statistics & numerical data; D000097627:Cefpodoxime Proxetil
chemical_list: D000658:Amoxicillin; D019980:Amoxicillin-Potassium Clavulanate Combination; D000900:Anti-Bacterial Agents; D015296:Ceftizoxime; D000097627:Cefpodoxime Proxetil
keywords: Acute otitis media; Antibiotics; Antibiotiques; Otites moyennes aiguës; Pediatric emergency department; Urgences pédiatriques