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Compliance with prophylactic antibiotics for otitis media in a New York City clinic
1Department of Otolaryngology, New York University Medical Center, NY 10016.
Insights
Antibiotic compliance for preventing otitis media in urban children is low, with less than half adhering to treatment. Alternative therapies like ear tubes may be necessary for this population.
Area of Science:
- Pediatric Otolaryngology
- Infectious Disease Prevention
- Public Health
Background:
- Previous studies show high antibiotic compliance for otitis media prevention in private practice.
- Compliance in lower socioeconomic, urban clinic populations remains poorly understood.
- Otitis media is a common childhood infection requiring effective management strategies.
Purpose of the Study:
- To estimate antibiotic compliance rates in urban, lower socioeconomic children receiving prophylactic treatment for otitis media.
- To identify factors influencing compliance within this specific patient population.
- To inform clinical practice regarding treatment adherence for otitis media prevention.
Main Methods:
- Prospective follow-up of 80 children on daily low-dose antibiotics in a pediatric otolaryngology clinic.
- Compliance estimation based solely on parent's self-reported adherence.
- Analysis of demographic and treatment-related factors potentially affecting compliance.
Main Results:
- Only 46.8% of families reported compliance; 23.4% admitted non-compliance.
- 29.9% of patients did not attend follow-up visits reliably.
- No single patient or treatment characteristic strongly correlated with compliance levels.
Conclusions:
- Antibiotic compliance for otitis media prevention is significantly lower than previously reported in urban, underserved populations.
- Clinicians should consider alternative treatments, such as middle ear ventilation tubes, for children with suspected poor adherence.
- Further research is needed to optimize treatment strategies for otitis media in diverse socioeconomic settings.
Abstract:
Although previous efficacy studies have reported high compliance rates among children treated by private physicians with prophylactic antibiotics for prevention of otitis media, compliance rates in a lower socioeconomic, urban clinic population have not been well described. Eighty children who were placed on daily low dose antibiotics in the Pediatric Otolaryngology Clinic at Bellevue Hospital were prospectively followed in order to estimate compliance in this population. Compliance was estimated by the parent's stated word alone. Of the 77 patients with records adequate for analysis, only 36 (46.8%) families claimed compliance, 18 (23.4%) admitted non-compliance, and 23 (29.9%) did not reliably return for follow-up clinic visits. Statistical analysis revealed that no single characteristic of the patient population or the treatment regimen strongly influenced compliance. The factors examined included: the child's age, sex, race and otologic diagnosis, the type of prophylaxis prescribed, the parent's ability to speak English, national origin, consistency of follow-up, and method of payment. Based on these results, less than half of the children attending an inner city clinic compiled with maintenance medication. The clinician should consider alternate treatment modalities, such as the insertion of middle ear ventilation tubes, if poor compliance with prolonged antibiotic treatment is suspected.