Knowledge and practices relating to the 2004 acute otitis media clinical practice guideline: a survey of practicing...

To identify primary care physicians' familiarity with the 2004 acute otitis media (AOM) clinical practice guideline and to compare their practices with its recommendations.

Mail survey October through December 2004 to all active physician members of the Slone Center Office-based Research Network, a national, practice-based, pediatric research network.

The response rate was 276 of 469 (58.8%). Overall, 90.5% had read the guideline or summaries of it. Pneumatic otoscopy was always used by 16.2%, used half the time or more by 23.1%, used less than half the time by 34.6% and never used by 26.2%. Observation is considered a reasonable option for some AOM cases by 88.0% and, over the previous 3 months, these physicians used observation a median of 10% of the time (25th and 75th percentiles, 5% and 25%, respectively). In terms of concern that the observation option may increase AOM complications, 75.6% were not at all or only slightly concerned; 24.4% were moderately or very concerned. In general, these physicians have altered their antibiotic prescribing practices for AOM towards the guideline's recommendations since its publication. However, antibiotic choices deviated most widely from the guideline in cases of AOM with severe illness, where only 17.9% follow the recommendation for high-dose amoxicillin-clavulanate, and in cases of children who fail treatment with amoxicillin-clavulanate, where only 27.7% favor the recommended intramuscular ceftriaxone.

Most physicians in this survey are familiar with the AOM guideline, but many do not follow its diagnostic and antibiotic recommendations. Observation for selected cases is acceptable to most of these physicians and is currently used in a small proportion of cases.