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Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

David L Brinker1, Erina L MacGeorge1, Nicole Hackman2

  • 11 The Pennsylvania State University, University Park, PA, USA.

Clinical Pediatrics
|October 13, 2018
PubMed

Insights

Watchful waiting (WW) for acute otitis media (AOM) is underutilized. Many AOM diagnoses lacked physical exam support, leading to unnecessary antibiotic prescriptions. WW instructions reduced antibiotic use by 57%.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Pharmacology

Background:

  • Current guidelines suggest watchful waiting (WW) for acute otitis media (AOM).
  • High antibiotic use indicates potential underutilization of WW.
  • Pediatric AOM management requires optimization for antibiotic stewardship.

Purpose of the Study:

  • To evaluate the underutilization of WW in pediatric AOM.
  • To assess diagnostic consistency with guidelines and its impact on antibiotic prescribing.
  • To analyze WW instruction compliance and prescription filling behaviors.

Main Methods:

  • Retrospective chart review of 474 pediatric AOM cases.
  • Assessment of physical examination findings, diagnostic behavior, and WW utilization.
  • Evaluation of antibiotic prescription rates, WW instructions, and prescription filling.

Main Results:

  • 50% of AOM diagnoses lacked supporting physical examination findings.
  • Unsupported AOM diagnoses frequently resulted in antibiotic prescriptions.
  • WW instructions led to 57% fewer filled prescriptions and delayed filling.

Conclusions:

  • Injudicious antibiotic prescribing for pediatric AOM is prevalent.
  • Improved diagnostic accuracy and adherence to WW guidelines can enhance antibiotic stewardship.
  • Implementing WW strategies is crucial for reducing unnecessary antibiotic use in pediatric AOM.

Keywords:
antibiotic prescribingpediatric acute otitis mediawatchful waiting

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