Management of acute otitis media with otorrhea in Italian pediatric practice: a national survey

Acute otitis media (AOM) is a common pediatric infection, and spontaneous tympanic membrane perforation and otorrhea represent a clinically significant subset that requires specific management. Understanding current practices among pediatricians is crucial for identifying areas of concordance with guidelines, management strategies, and potential educational needs.

A national survey was conducted among Italian pediatricians, including both family pediatricians and hospital-based specialists, to assess their attitudes and practices regarding the definition, epidemiology, diagnosis, and treatment of AOM with otorrhea. A dedicated questionnaire included 20 items concerning different aspects of AOM management, including the potentiality of topical treatment for otorrhea. Data were also stratified for age, type of work, and geographic area.

Five hundred pediatricians participated in the survey. The survey revealed that 57.6% of respondents preferred "acute otitis media with otorrhea" as the disease definition. AOM with otorrhea is most frequently observed in winter (45%) and autumn/spring (25% each). Approximately two-thirds of pediatricians (66%) manage 5-20 cases monthly during peak incidence. Otorrhea is reported in <10% of AOM cases by 58.6% of practitioners. A substantial majority (80.2%) initiate antibiotic treatment at the first observation in the presence of otorrhea, primarily systemic (78.2%), with amoxicillin-clavulanate (60.2%) being the preferred drug for 8-10 days (72.4%). Recurrences within 3 months are reported by 72.8% of respondents, with <10% of patients reporting them. There is raised interest in treatment alternatives (85.8%) and a preference for topical administration for specific patient categories (60.6%).

This national survey suggests that Italian pediatricians commonly favor early antibiotic treatment for acute otitis media with otorrhea, while areas of uncertainty remain regarding watchful waiting, treatment duration, and the role of topical therapy. These findings highlight the need for clearer, practice-oriented guidance and further research.