Appropriate and Inappropriate Treatment of Acute Otitis Media in the Pediatric Emergency Room

Background: Over-treatment of acute otitis media (AOM) with antibiotics is common, and poses a high burden on healthcare systems.

Methods: Records of children 6-36 months of age with AOM visiting a university-affiliated pediatric emergency department (PED) between 2014-2016 were reviewed for the treatment given: watchful waiting (WW) vs. antibiotics. If antibiotics were prescribed, the type and duration were recorded. We evaluated appropriate and inappropriate treatment rates of eligible AOM cases, in respect to the local guidelines, which encourage WW in most mild-moderate cases.

Results: Out of 1493 AOM visits, 863 (57.8%) were boys, with a median age of 14.9 months (IQR, 9-19). The overall pre-visit antibiotic rate was 24.1%, but among those children examined by a physician, this rate was 95.2%. Amoxicillin was the most common antibiotic, administered in 66.3% of the cases. Only 21 (5.8%) children had been treated with antibiotics for ≥7 days prior to their visit, and were considered as treatment failure. Antibiotic therapy upon discharge was recorded in 1394/1449 (96.2%) visits, again with amoxicillin as the most common antibiotic therapy, in 80.8% of the cases. In these visits, the average duration of antibiotic treatment was 8.29 days. Appropriateness of treatment (WW or antibiotics) could be analyzed in 1134 visits; 20.9% were considered as inappropriate. Of them, 98.3% were prescribed with the wrong antibiotic type and duration.

Conclusion: Adherence rate to the local guidelines treatment recommendations for uncomplicated AOM was high, as measured by whether appropriate treatment was given and type and duration of antibiotics.