Adherence to Acute Otitis Media Diagnosis and Treatment Guidelines Among Israeli Otolaryngologists

Introduction: The recent Israeli acute otitis media (AOM) guidelines, drafted mainly by pediatricians and family physicians in 2013, addressed diagnostic and therapeutic issues, in order to reduce over-diagnosis and treatment. These guidelines are considered as the `standard of care` for AOM management. While the adherence rate of pediatricians to previous Israeli AOM guidelines (2004) was reported to be high (>85%), the compliance of otolaryngologists has not been studied.

Methods: An anonymous 19-item questionnaire was circulated among practicing Israeli otolaryngologists (residents [n=93], specialists [n=283]). All the items were scored according to the number of correct answers in line with the guidelines, and summed on a 0-100 scale.

Results: Response rate was 34% (n=127). Overall, scores of correct answers of residents (n=48, 52% of all residents) and specialists (n=79, 28% of all specialists) were similar, and showed comparable moderate adherence to both guidelines: 55.7 vs 58.3 (p=0.26). Residents were more likely to adhere to the U.S. guidelines, when compared to specialists (score difference 6.1 vs 2.8, p=0.008). Responders preferred the microscope for diagnosis (48%), over the recommended (pneumatic) otoscope (62%) (p=0.05), and were more likely to start antibiotic therapy (62%), rather than the `watchful waiting’ (38%) (p=0.03). Concerning antibiotic treatment, 50% of otolaryngologists prescribed amoxicillin as recommended, at 60-80 mg/kg/d.

Conclusion: The moderate adherence rate suggests that the guidelines were partially adopted by otolaryngologists, who use different instrumentation than recommended, and treat more severe/complicated cases. Over-treatment with antibiotics and inaccurate dosing regimens are still common. Better implementation of the AOM guidelines among otolaryngologists should be performed in designated training platforms.