This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (20) Citing Articles via Google Scholar Google Scholar Articles by Garbutt, J. Articles by Shackelford, P. Search for Related Content PubMed PubMed Citation Articles by Garbutt, J. Articles by Shackelford, P. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?

PEDIATRICS Vol. 112 No. 1 July 2003, pp. 143-149

Diagnosis and Treatment of Acute Otitis Media: An Assessment

Jane Garbutt, MBChB, FRCP(C)^*, Donna B. Jeffe, PhD^*,, Penelope Shackelford, MD

^* Division of General Medical Sciences
Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri

Objective. To assess compliance with the Centers for Disease Control and Prevention (CDC) evidence-based guidelines for the judicious use of antimicrobials in children with acute otitis media (AOM).

Methods. Compliance with CDC’s recommended diagnostic criteria and antimicrobial treatments for management of AOM was assessed by chart review and self-report for 29 community pediatricians in St. Louis, Missouri. For each physician, a simple random sample of AOM visits was selected and reviewed by trained reviewers. In addition, each physician completed a questionnaire.

Results. Compliance with recommended diagnostic criteria was 38% (95% confidence interval: 34%–42%; n = 573) by chart audit and 41% (95% confidence interval: 24%–61%; n = 29) by self-report. Antimicrobial selection assessed by chart audit was consistent with CDC guidelines in 68% (95% confidence interval: 64%–72%) of visits for a new infection, 63% (95% confidence interval: 47%–78%) of visits for treatment failure, and 50% (95% confidence interval: 33%–67%) for recurrent disease. Self-reported compliance with treatment guidelines for new infection was 100% (95% confidence interval: 88%–100%) and 83% (95% confidence interval: 64%–94%) for treatment failure. Noncompliance was most frequently attributable to overuse of broad-spectrum antimicrobials. Most patients treated with amoxicillin received a 10-day course (98%). Subtherapeutic dosing occurred in 26% of patients treated with amoxicillin.

Conclusions. Overdiagnosis of AOM is common. Efforts to improve the judicious use of antimicrobials for AOM should focus on improving diagnostic accuracy, limiting the use of broad-spectrum antimicrobials to cases where they offer clinical benefit, and ensuring that amoxicillin dosing regimens are optimal.

---

Key Words: acute otitis media • guidelines • antimicrobial

Abbreviations: CDC, Centers for Disease Control and Prevention • AOM, acute otitis media • MEE, middle ear effusion • TM, tympanic membrane • MIC₉₀, minimum inhibitory concentration

---

Received for publication Oct 11, 2002; Accepted Mar 31, 2003.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. Lopez-de-Andres, P. Carrasco-Garrido, V. Hernandez-Barrera, A. G. de Miguel, and R. Jimenez-Garcia Coverages and factors associated with influenza vaccination among subjects with chronic respiratory diseases in Spain Eur J Public Health, April 1, 2008; 18(2): 173 - 177. [Abstract] [Full Text] [PDF]

				C. M. Sox, J. A. Finkelstein, R. Yin, K. Kleinman, and T. A. Lieu Trends in Otitis Media Treatment Failure and Relapse Pediatrics, April 1, 2008; 121(4): 674 - 679. [Abstract] [Full Text] [PDF]

				D. A. Varrasso, D. Ashe, R. Ruben, and R. Propp Watchful Waiting for Acute Otitis Media: Are Parents and Physicians Ready? Pediatrics, August 1, 2006; 118(2): 849 - 850. [Full Text] [PDF]

				R. M. Siegel, J. Bien, P. Lichtenstein, J. Davis, J. C. Khoury, J. E. Knight, M. Kiely, and J. Bernier A Safety-Net Antibiotic Prescription for Otitis Media: The Effects of a PBRN Study on Patients and Practitioners Clinical Pediatrics, July 1, 2006; 45(6): 518 - 524. [Abstract] [PDF]

				D. O. Francis, H. Beckman, J. Chamberlain, G. Partridge, and R. A. Greene Introducing a Multifaceted Intervention to Improve the Management of Otitis Media: How Do Pediatricians, Internists, and Family Physicians Respond? American Journal of Medical Quality, March 1, 2006; 21(2): 134 - 143. [Abstract] [PDF]

				F. Marchetti, L. Ronfani, S. C. Nibali, G. Tamburlini, and for the Italian Study Group on Acute Otitis Media Delayed Prescription May Reduce the Use of Antibiotics for Acute Otitis Media: A Prospective Observational Study in Primary Care Arch Pediatr Adolesc Med, July 1, 2005; 159(7): 679 - 684. [Abstract] [Full Text] [PDF]

				T. Zink, R. Siegel, L. Chen, L. Levin, S. Pabst, and F. Putnam Physician Knowledge and Management of Children Exposed to Domestic Violence in Ohio: A Comparison of Pediatricians and Family Physicians Clinical Pediatrics, April 1, 2005; 44(3): 211 - 219. [Abstract] [PDF]

				R. M. Siegel and J. P. Bien Acute Otitis Media in Children: A Continuing Story Pediatr. Rev., June 1, 2004; 25(6): 187 - 193. [Full Text] [PDF]

				S. M. H. Nainar and S. Mohummed Role of Infant Feeding Practices on the Dental Health of Children Clinical Pediatrics, March 1, 2004; 43(2): 129 - 133. [PDF]