Acute otitis media in children: a retrospective analysis of physician prescribing patterns

Acute otitis media (AOM) is one of the most common infectious diseases of childhood and the most frequent indication for antibiotic use in children. Aim To better understand the prescribing patterns and appropriateness of AOM therapy.

We investigated a historical cohort of children aged < or = 6 years who had a first AOM episode between June 1999 and June 2002, using the Régie de l'assurance maladie du Quebec (RAMQ) administrative databases. Conformity of prescription was based on the consensus guidelines on AOM treatment from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group. These recommendations suggested amoxicillin as the first-line drug, and amoxicillin-clavulanic acid or cefuroxime for children who had received antibiotics in the previous month. Data were analysed using descriptive statistics, chi(2) test and logistic regression.

During the study period, 60 513 children < or = 6 years of age experienced their first AOM episode with a mean age of 2.6 years. They were seen by 4708 physicians [87% general practitioners (GPs), 9% paediatricians, and 3% ENT specialists]. Amoxicillin was the antibiotic that was prescribed the most (43%), followed by cefprozil and azithromycin. Overall, 42% of physicians adhered to antibiotic guideline recommendations. Compared with GPs, paediatricians were almost as likely to prescribe in conformity with the consensus guidelines, whereas ENT specialists were 50% less likely to prescribe an antibiotic recommended by the guidelines.

Continuing medical education is necessary to ensure appropriate adherence to antibiotic guidelines.