Antibiotic Use and Parental Home Otoscopy

To the Editor.

Bauchner et al¹ and others² have called attention to injudicious antibiotic use, prompting calls for physician, as well as parent, reeducation. Confronted with an unhappy child who may have acute otitis media (AOM) and facing exhausted parents, physicians may find themselves under pressure to prescribe.^{3 ,4} Excessive prescriptions for antibiotics increase costs, engender toxicity, and promote relative and absolute resistance to antimicrobials. More stringent diagnostic criteria, shorter courses of medication, and specified clinical parameters have been proposed to reduce unnecessary antibiotic use.^1–5However, the impact of such measures may be hard to assess, and desired changes may be slow in coming. Moreover, these strategies offer no mechanism for reassessing what is going on in the middle ear other than repeated visits to the doctor.

A different approach aims to reduce physician intervention by training parents in rudimentary home otoscopy. This approach is based on the recognition that most uncomplicated AOM is self-resolving.^{3 ,6} The goal …