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Guideline fails to reduce antibiotic prescribing

The percentage of children who received antibiotics for acute otitis media (AOM) did not change significantly after a 2004 clinical practice guideline recommended “watchful waiting” for certain patients, according to data from the National Ambulatory Medical Care Survey (NAMCS). However, analgesic prescribing increased 71% after the guideline strongly recommended treating pain associated with AOM.

The American Academy of Pediatrics and American Academy of Family Physicians issued the clinical practice guideline on the management of AOM in children ages 6 months through 12 years. The guideline called for the option of observing children with AOM before prescribing antibiotics based on age, severity of symptoms and certainty of diagnosis. It also recommended specific antibiotics based on severity of illness and treatment response.

Researchers analyzed data from the NAMCS from before and after publication of the guideline to measure changes in the management of AOM. Results showed that 48% of patients with AOM were younger than 2 years of age, and pediatricians treated 82% of the patients.

The percentage of children who were managed without antibiotics did not change significantly (11% before publication of the guideline vs. 16% afterward). Absence of ear pain, absence of fever and receipt of an analgesic prescription were independent predictors of antibiotics not being prescribed.

In accordance with the guideline, the prescribing of amoxicillin increased from 40% to 49%, and the rate of analgesic prescribing increased from 14% to 24%. Contrary to the guideline, the prescribing of amoxicillin/clavulanate for severe infection decreased from 23% to 16%, whereas the prescribing of cefdinir increased from 7% to 14%.

The authors concluded that it appears physicians are hesitant to use the observation option, perhaps due to parental pressure and barriers to follow-up. In addition, cefdinir has become a popular second-line agent perhaps due to its convenient dosing schedule, lower incidence of diarrhea or more aggressive marketing.

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