Patterns in acute otitis media drug prescriptions: a survey of Italian pediatricians and otolaryngologists

Abstract

Objective: To evaluate whether physicians follow current guidelines for managing acute otitis media (AOM) and whether educational programs are needed to improve knowledge of AOM treatment among paediatricians (PEDs) and otolaryngologists (ENTs) Methods: A total of 1270 PEDs and 852 ENTs were randomly selected and interviewed with an anonymous questionnaire about how they managed AOM. Results: Inappropriate AOM approaches were identified among 60.2% of PEDs and 88.5% of ENTs (p < 0.001). Amoxicillin and amoxicillin with clavulanic acid were appropriately chosen as first-line drugs by the majority of PEDs and ENTs, although significantly more ENTs reported otherwise (15.8% PEDs vs 25.5% ENTs; p < 0.001). ENTs were significantly more likely than PEDs to report prescribing decongestants, mucolytics, anti-inflammatory drugs, and steroids (p < 0.001). Conclusion: These results show that AOM prescriptions for antibiotics and adjunctive treatments are often inappropriate and highlight the need for educational strategies aimed at PEDs and ENTs to improve their compliance with evidence-based guidelines for AOM treatment.

Keywords::

• acute otitis media
• adjunctive treatment
• antimicrobial therapy
• ear
• otitis
• prescribing habits

Financial & competing interests disclosure

This study was supported in part by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Overprescribing in acute otitis media (AOM) is frequent and this has resulted in medical, social and economic problems.

• In this study, most of the surveyed physicians did not follow recommended prescription practices for antibiotics and adjunctive treatments for AOM.

• There were substantial differences in prescription practices between pediatricians and otolaryngologists (ENTs); ENTs were more likely to not prescribe an appropriate AOM treatment.

• Primary care physicians were more likely than hospital-based physicians to not adhere to AOM treatment guidelines.

• Our findings highlight the need for specific training and education to improve pediatrician and ENT compliance with evidence-based guidelines.

• Future studies comparing management of AOM at least between European countries and the USA are needed.