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Watchful Waiting for Acute Otitis Media.
Nicole E Smolinski1,2, Patrick J Antonelli2,3, Almut G Winterstein1,2,4
1Department of Pharmaceutical Outcomes and Policy, College of Pharmacy.
Pediatrics
|June 21, 2022
Summary
Watchful waiting for acute otitis media (AOM) is underused in children, with only 22.2% of cases managed this way. Clinician prescribing habits, not patient factors, significantly influence this treatment approach.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Services Research
Background:
- Updated guidelines recommend watchful waiting for uncomplicated acute otitis media (AOM).
- However, the prevalence and determinants of this approach in pediatric care remain unclear.
Purpose of the Study:
- To determine the treatment prevalence of watchful waiting for AOM in commercially insured pediatric patients.
- To identify associated determinants of watchful waiting for AOM.
Main Methods:
- Retrospective cohort study using IBM Marketscan Commercial Claims Databases (2005-2019).
- Included patients aged 1-12 years with AOM and no complications.
- Analyzed antibiotic treatment prevalence and used logistic regression to examine determinants of watchful waiting.
Main Results:
- 77.8% of AOM episodes received antibiotic treatment within 3 days.
- Clinician antibiotic prescribing volume and specialty were strong determinants of watchful waiting.
- Low-volume prescribers and otolaryngologists were more likely to use watchful waiting.
Conclusions:
- Adoption of watchful waiting for uncomplicated AOM is limited and stagnant.
- The approach is driven by clinician factors rather than patient factors.
- Further research should explore prescribing motivators and patient outcomes.
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