Treatment, Failure, Recurrence, and Antibiotic Prescription Rates for Different Acute Otitis Media Treatment Methods

Abstract

This retrospective analysis from Woodcreek Healthcare Inc., in Puyallup, Washington, evaluated acute otitis media (AOM) episodes managed with either immediate antibiotics (ABX), typmanocentesis + observation (Tap+OBS), or tympanocentesis + immediate antibiotics (Tap +ABX) and the rates of acute otitis media treatment failure (AOMTF), recurrent acute otitis media (RAOM), and antibiotic prescription rates for each treatment group. Diagnostic criteria for AOM were a bulging or full tympanic membrane accompanied by otalgia, fever, or parent-reported irritability or sleeplessness. Any instance of a patient returning to clinic and receiving a subsequent diagnosis of AOM within 10 days of initial diagnosis was defined as AOMTF. RAOM was defined as any instance of a patient returning to clinic and receiving a subsequent diagnosis of AOM 11–30 days after an initial diagnosis. Two cohorts of patients were included in the study. The first cohort included all patients younger than 37 months who received tympanocentesis for AOM from July 1, 2005 to July 30, 2009. This cohort was either immediately treated with antibiotics or observed based on the decision of the treating physician. The second cohort of patients included in the study received immediate antibiotic therapy for AOM during the same period. AOMTF, RAOM, and antibiotic prescription data were analyzed for the first, second, and third AOM episodes experienced by each patient in the second cohort (ABX-1, 2, or 3). The data collected were then assessed using the Fisher exact test (two-tailed). There were 212 patients identified to have AOM and treated with tympanocentesis. Of these patients, 12 episodes of AOM were excluded due to insufficient post-treatment data. The second cohort produced 128 patients that were treated with antibiotics. Twenty-one of these patients were excluded from the study due to insufficient post-treatment data. The 30-day antibiotic prescription rate was 27% (one prescription per 3.8 episodes) in the Tap+OBS group vs. ∼ 120% (1.2 prescriptions per episode) in each of the immediate antibiotic groups (p<0.001). There were no significant differences in AOMTF or RAOM between any of the treatment groups. The authors concluded that antibiotics provide marginal benefit for most AOM episodes. Alternatives to AOM therapies can help reduce reliance on antibiotics without inviting significant increases in rates of clinical failure.