Acute Otitis Media in Childhood - Use of Guidelines for Diagnosis and Treatment in Emergency Rooms

Eduardo Jorge Da Fonseca Lima,Patrícia Gomes De Matos Bezerra,Fernanda Zeilmann Cazzetta,Pedro Jorge Serra Da Fonseca Lima,Caroline Cordeiro De Andrade,Maria Eduarda De Araújo Cabral

doi:10.11648/j.ajp.20190503.13

Abstract

Background: AOM is characterized by its high prevalence and morbidity but low lethality. It is estimated that 70% of children will have had one episode prior to completing five years of age Compliance with the guidelines for acute otitis media (AOM) may avoid complications. This study aimed at determining whether pediatricians follow the guidelines for AOM management. Methods: A prospective, cross-sectional study involving pediatricians working in emergency centers in Recife. A specific questionnaire was used to collect data. Results: Of the 71 pediatrics interviewed around 98% gave importance to crying/irritability and otalgia when diagnosing otitis and all recognized the significance of otorrhoea. All the professionals gave importance to bulging tympanic membrane, 98.6% to acute tympanic membrane perforation, 97.1% to purulent effusion and 46.5% to bilateral hyperemia of the tympanic membrane. Regarding antibiotic therapy, 70.4% used standard doses of amoxicillin as first-line treatment (81.7% prescribing for 10 days). Furthermore only 47.9% double the dose in case of therapeutic failure. Conclusion: Pediatricians working in emergency departments need to be better informed about the guidelines to decrease inappropriate prescription of antibiotics for AOM. We believe that adoption of the “wait and see” strategy, even in emergency rooms, would be an important means of reducing the inadequate prescription of antibiotics in cases of AOM, thus contributing towards reducing bacterial resistance.

Highlights

Acute otitis media (AOM) is an inflammation of the middle ear mucosa
The sample consisted of 71 paediatricians working at public and private emergency departments in three hospitals in the city of Recife
The Academy of Paediatrics (AAP) published its guidelines for the diagnosis and treatment of acute otitis media (AOM) with the objective of helping primary care physicians manage the disease

Summary

Introduction

Acute otitis media (AOM) is an inflammation of the middle ear mucosa It is generally associated with the rapid onset of signs and symptoms of an acute middle ear infection, involving fever, otalgia and irritability. It is estimated that 70% of children will have had one episode prior to completing five years of age. [3,4] In a cohort study, 71% of the children evaluated had had one or more episodes of AOM prior to completing three years of age, with the condition being more prevalent in boys. 70% of children will have had one episode prior to completing five years of age Compliance with the guidelines for acute otitis media (AOM) may avoid complications. Conclusion: Pediatricians working in emergency departments need to be better informed about the guidelines to decrease inappropriate prescription of antibiotics for AOM. We believe that adoption of the “wait and see” strategy, even in emergency rooms, would be an important means of reducing the inadequate prescription of antibiotics in cases of AOM, contributing towards reducing bacterial resistance

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