Therapeutic approach to acute otitis media in primary care in an urban area. Delayed antibiotic prescription evaluation

Abstract

Background and objectives: Acute otitis media (AOM) is one of the most frequent causes of consultation and antibiotic prescription in pediatrics. The objective of this work is to evaluate the practice of delayed antibiotic prescription in AOM in pediatrics in primary care.

Material and methods: Observational, retrospective study, through reviewing of medical records in a Primary Care Center of Aragon Community of children with OMA in which doctors perform delayed prescription. Logistic regression analyzes possibly related to antibiotic prescription factors.

Results: 1390 episodes of AOM are analyzed in 696 patients. Immediate antibiotic prescription is performed in 67.6% (95% CI: 65.1-70.0%) of episodes, exclusive symptomatic in 13.7% (IC 95: 11.9-15.6%), and delayed antibiotic in 18.7% (IC 95: 16.7%-20.8%), finally being given in 53.5% (IC 95: 47.4-59.5%) of these. Factors significantly related to final antimicrobial dispensation in delayed prescription are aged between 0 and 2 years (OR 1.89, 95% CI: 1.25-2.87), bilaterality (OR 2.54, 95% CI: 1.48-4.35), ear pain (OR 0.49, CI 95: 0.29-0.82), fever (OR 2.67, IC 95: 1.95-3.65), bulging (OR 3,63; IC 95: 2,50-5,29) and otorrhea (OR 25.98; IC 95: 12.75-52.92). The same factors have influence on global prescription of antibiotics. Amoxicillin (74.6%) is the most indicated antibiotic, followed by Amoxicillin-Clavulanic (17.0%).

Conclusions: Delayed prescription in AOM seems to be useful to reduce antibiotics consumption, being necessary to advance in its implantation.

Keywords: Acute otitis media; Administración y dosificación de antibacterianos; Administration and dosage; Antibacterial agents; Antimicrobial stewardship; Child; Drug administration schedule; Esquema de administración; Niños; Optimización del uso de los antimicrobianos; Otitis media.