Antibiotic prescription rates changed little after AOM guidelines issued

Five years have passed since the American Academy of Pediatrics and the American Academy of Family Physicians suggested watchful waiting as an approach to acute otitis media treatment, but physicians are still prescribing antibiotics as much as they did before the guidelines, according to the results of a study reported online yesterday in Pediatrics.

Andrew Coco, MD, of Lancaster General Research Institute in Pennsylvania and colleagues analyzed data from 1,114 children who were diagnosed with AOM and who participated in the 2002 to 2006 National Ambulatory Medical Care Survey.

The researchers compared the 30-month periods before and after the guideline was released in 2004 and found that the rate of AOM encounters at which no antibiotic prescribing was reported remained about the same (11%-16%; P=.103). They identified the following factors as independent predictors of antibiotic nonprescription: absence of fever, ear pain and receipt of an analgesic prescription.

Contrary to guideline recommendations, the rate of amoxicillin/clavulanate actually decreased, whereas cefdinir use increased, the researchers noted. Amoxicillin prescription rates rose (40%-49%; P=.039), as did the rate of analgesic prescribing (14%-24%; P = .038).

In an accompanying editorial, Robert M. Siegel, MD, of Cincinnati Children’s Hospital Medical Center in Ohio, emphasized the importance of shared decision making when prescribing antibiotics. He said educating families regarding antibiotic use and ensuring that the child’s ear pain is adequately managed would likely lead to decreased antibiotic use.

Coco A. Pediatrics. 2010; doi:10.1542/peds.2009-1115.