Abstract
BackgroundAcute otitis media (AOM) is one of the most common childhood infectious diseases. The recent Italian Pediatric Guidelines for the treatment of AOM constitutes a step forward in the management of children with uncomplicated AOM. The aim of this study was to evaluate antibiotic prescription patterns for AOM in a Pediatric Emergency Department (PED) after those guidelines were introduced and to assess the relationship between implementation of the “watchful waiting” strategy and the incidence of acute mastoiditis in the PED.MethodsThis retrospective study was conducted between 1st January 2007 to 31st December 2013 at the PED of the University of Modena and Reggio Emilia in Modena (Italy). All children between 0 and 14 years who were examined because of symptoms and/or signs of AOM and acute mastoiditis were enrolled. Pearson’s chi-squared test was used to evaluate if introduction of the Italian Paediatric Guidelines was associated with a reduction in the antibiotic prescription pattern in children with AOM and/or with an increase in mastoiditis frequency.Results4,573 (89.4%) patients were included in our analysis, antibiotics were prescribed to 81% cases of the children diagnosed with AOM. The frequency of antibiotic prescribing continued to be stable after the Italian guidelines were introduced (82% versus 81%).Forty children were admitted to hospital with a diagnosis of acute mastoiditis. Our study did not find any association between the number of cases of acute mastoiditis and the percentage of patients treated with antibiotics; the annual incidence of mastoiditis before and after the new guidelines were published was, in fact, stable.ConclusionsDespite the diffusion of clinical guidelines recommending a “watchful waiting” approach for children with AOM, the antibiotic prescription rate continues to be high. It appears to be more difficult to impact the percentage of cases for which antibiotics are prescribed than the type of antibiotic that is utilized. In view of these findings, a close follow-up control by the primary care paediatrician or a scheduled follow-up appointment at the PED and incisive campaigns to promote parents’ awareness of proper antibiotic use appear to be warranted.
Highlights
Acute otitis media (AOM) is one of the most common childhood infectious diseases
A total of 127,866 children were examined in the Pediatric Emergency Department (PED) during the study period; 5,115 of these were originally considered eligible for inclusion (Figure 1)
Excluding 14 children who were already receiving an antibiotic before presenting at the PED, antibiotics were prescribed to 81% cases of the children diagnosed with AOM (Table 1)
Summary
Acute otitis media (AOM) is one of the most common childhood infectious diseases. The recent Italian Pediatric Guidelines for the treatment of AOM constitutes a step forward in the management of children with uncomplicated AOM. The aim of this study was to evaluate antibiotic prescription patterns for AOM in a Pediatric Emergency Department (PED) after those guidelines were introduced and to assess the relationship between implementation of the “watchful waiting” strategy and the incidence of acute mastoiditis in the PED. Acute otitis media (AOM) is the most common disease for which children receive antibiotics [1]. Palma et al Italian Journal of Pediatrics (2015) 41:37 which recommends antibiotic treatment for children who remain symptomatic for 72 hours is based on studies demonstrating that AOM heals spontaneously in 80% of cases [11]. The Italian guidelines recommend that “antibiotic treatment should be prescribed immediately for severe cases of AOM, for children younger than two years with bilateral AOM, and cases of spontaneous perforation. Amoxicillin was indicated in the guidelines as the first choice drug in the case of AOM in children at low risk of resistant pathogens [12]
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