Antibiotic prescription patterns for management of acute otitis media in Lebanon
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Published on: January 18, 2018
Ali Nasrallah1, Ali Bacharouch1, Fadia Jaafar2
1University of Michigan Medical School, Ann Arbor, MI, USA.
Objectives:
The high incidence of Acute Otitis Media (AOM) along with low antibiotic efficacy in the treatment of AOM is particularly favorable for the emergence of antimicrobial resistance. The promotion of more conservative antibiotic prescription habits has become an important focus of governments and academic societies. Little is known about the awareness and use of AOM practice guidelines by physicians in the Middle East. Our aim is to characterize AOM management in Lebanon by using an anonymous survey instrument to uncover potential disparities in treatment trends and evaluate differences in clinical guideline adherence patterns.
Methods:
A total of 75 practicing physicians were anonymously surveyed in Beirut, Saida, Nabatieh, Bekaa and Tripoli, Lebanon. The survey tool used was previously used in Amman, Jordan by our colleagues at the University of Michigan. The survey we used assessed awareness of and adherence to practice guidelines by prompting responses to hypothetical AOM cases. Differences in performance between various physician groups were noted.
Results:
Overall, physician participants answered 67% of the survey questions correctly. Trainees did better overall in terms of AOM management (62% correct responses as compared to 48% in attending physicians, p = 0.0175). Trainees also performed better in terms of their ability to manage cases of potential AOM in two-year old children and their ability to choose the appropriate medications (79% correct response rate compared to 71% in attending physicians, p = 0.0278). Participants who reported guideline adherence most or all of the time had a 67% correct response rate in regards to their ability to diagnosis AOM, compared to a 57% correct response rate in those who reported adhering sometimes or rarely to the guidelines (p = 0.0489). In the cases requiring antibiotic treatment for body temp of over 39C with/without otalgia, only 47-57% of participants identified the appropriate antibiotic regimen.
Conclusion:
There are areas of potential improvement in adherence to clinical guidelines in the management, diagnosis, and treatment of AOM by Lebanese physicians. Conducting interventions among physicians to improve awareness of clinical guidelines and current treatment recommendations in Lebanon will likely improve adherence to guidelines, enhance clinical outcomes, and may help advance the fight against antimicrobial resistance.
Insights
Physician adherence to Acute Otitis Media (AOM) guidelines in Lebanon shows room for improvement, particularly in antibiotic selection. Interventions can enhance AOM management and combat antimicrobial resistance.
Area of Science:
- Infectious Diseases
- Public Health
- Pediatrics
Background:
- Acute Otitis Media (AOM) presents a significant challenge due to rising antimicrobial resistance and suboptimal antibiotic efficacy.
- Conservative antibiotic prescribing is a global health priority, necessitating better adherence to clinical guidelines.
- Physician awareness and application of AOM management guidelines in the Middle East remain understudied.
Purpose of the Study:
- To assess the awareness and adherence to AOM practice guidelines among physicians in Lebanon.
- To identify potential disparities in AOM treatment trends and guideline implementation.
- To evaluate physician performance in managing hypothetical AOM cases.
Main Methods:
- An anonymous survey was administered to 75 practicing physicians across five Lebanese cities.
- The survey tool assessed guideline awareness and adherence through responses to simulated AOM clinical scenarios.
- Data analysis compared performance across different physician groups, including trainees and attending physicians.
Main Results:
- Physicians correctly answered 67% of survey questions, indicating variable guideline adherence.
- Trainee physicians demonstrated superior performance in AOM management compared to attending physicians (62% vs. 48% correct).
- Accurate identification of appropriate antibiotic regimens for AOM requiring treatment was suboptimal, with only 47-57% of participants selecting the correct options.
Conclusions:
- Lebanese physicians show potential for improvement in AOM diagnosis, management, and treatment guideline adherence.
- Targeted educational interventions can enhance physician awareness of AOM guidelines and improve clinical outcomes.
- Strengthening guideline adherence is crucial for combating antimicrobial resistance and optimizing AOM patient care.
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