Acute Otitis Media Guidelines, Antibiotic Use, and Shared Medical Decision-Making

Acute otitis media (AOM) continues to be the most common reason practitioners prescribe antibiotics for children.¹ Concern over emerging resistance of the common pathogens that cause AOM has led to efforts for more judicious use of antibiotics by being more careful in making the diagnosis, selecting narrow-spectrum antibiotics, and using analgesics instead of antibiotics unless the infection fails to clear on its own.^2,3 In 2004, the American Academy of Family Physicians and the American Academy of Pediatrics jointly issued guidelines with criteria for making the diagnosis, endorsing an observation option for those without severe disease, and advocating more aggressive pain management.⁴

With their study in this month's issue of Pediatrics, Coco et al⁵ report on how the guidelines have altered physicians' prescribing habits when treating AOM. In their insightful examination of the enormous National Ambulatory Medical Care Survey (NAMCS) database, the authors demonstrate that the use of analgesics and the narrow-spectrum antibiotic amoxicillin by pediatricians has increased. This is noteworthy, because guidelines historically have had little impact on physician behavior.⁶ In addition, those who reported not using an antibiotic initially showed a short-lived rise in frequency, but there was ultimately no significant difference by the end of the study period. In an earlier study, Halasa et al⁷ examined the NAMCS and National …

Address correspondence to Robert M. Siegel, MD, Cincinnati Children's, Department of Pediatrics, 3333 Burnet Ave, Cincinnati, OH 45229. E-mail: bob.siegel{at}cchmc.org