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Consultations for middle ear disease, antibiotic prescribing and risk factors for reattendance: a case-linked cohort study.
Br J Gen Pract 2006; 56(524):170-5BJ

Abstract

BACKGROUND

Otitis media is the most common reason for children to receive antibiotics, but there is no evidence about the effect of prescribing on reattendance.

AIM

To evaluate the changing workload of middle ear disease in general practice, and the impact on surgery reattendance of prescribing antibiotics at first attendance.

DESIGN OF STUDY

A case-linked cohort analysis for antibiotic prescribing versus no prescribing at first consultation event.

SETTING

Two hundred and ninety-one practices spread throughout the UK recording for the General Practice Research Database (GPRD) and incorporating individual patient data records for 2,265,574 patients.

METHOD

All middle ear disease coded events that can be classed within acute otitis media (AOM) or glue ear sub-categories (and excluding chronic suppurative otitis media) were selected for analysis when the first event was from 1991-2001. The effect of antibiotic prescription on the risk of reattendance using Cox proportional hazards regression was analysed.

RESULTS

Total consultations for AOM have fallen markedly over this decade, and glue ear consultations have risen but by a much smaller extent (26,000 decrease versus 4000 increase in consultations per year), which makes relabelling an unlikely explanation of the fall in AOM consultations. In the 2-10 years age range, consultations for AOM fell from 105.3 to 34.7 per 1000 per year, with glue ear consultations unaltered (15.2 to 16.7 per 1000 per year). Antibiotic prescribing for AOM has stayed remarkably constant (80-84% of consultations), but antibiotic prescribing for glue ear has risen sharply (13 to 62%). Prescribing antibiotics increased the risk of reattendance for AOM (hazard ratio [HR] = 1.09, 95% confidence interval [CI] = 1.07 to 1.10) and has reduced the risk of reattendance for glue ear (HR = 0.92, 95% CI = 0.88 to 0.96).

CONCLUSION

Prescribing antibiotics for AOM probably increased reattendance, but the opposite effect has been noted for glue ear, which suggests a treatment effect of antibiotics in glue ear. Further research is needed to clarify whether this possible benefit is worth the known harms, and if so in which subgroups of children.

Authors+Show Affiliations

Department of Primary Medical Care, Community Clinical Science Division, School of Medicine, University of Southampton, Southampton. I.G.Williamson@soton.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16536956

Citation

Williamson, Ian, et al. "Consultations for Middle Ear Disease, Antibiotic Prescribing and Risk Factors for Reattendance: a Case-linked Cohort Study." The British Journal of General Practice : the Journal of the Royal College of General Practitioners, vol. 56, no. 524, 2006, pp. 170-5.
Williamson I, Benge S, Mullee M, et al. Consultations for middle ear disease, antibiotic prescribing and risk factors for reattendance: a case-linked cohort study. Br J Gen Pract. 2006;56(524):170-5.
Williamson, I., Benge, S., Mullee, M., & Little, P. (2006). Consultations for middle ear disease, antibiotic prescribing and risk factors for reattendance: a case-linked cohort study. The British Journal of General Practice : the Journal of the Royal College of General Practitioners, 56(524), pp. 170-5.
Williamson I, et al. Consultations for Middle Ear Disease, Antibiotic Prescribing and Risk Factors for Reattendance: a Case-linked Cohort Study. Br J Gen Pract. 2006;56(524):170-5. PubMed PMID: 16536956.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Consultations for middle ear disease, antibiotic prescribing and risk factors for reattendance: a case-linked cohort study. AU - Williamson,Ian, AU - Benge,Sarah, AU - Mullee,Mark, AU - Little,Paul, PY - 2006/3/16/pubmed PY - 2006/8/10/medline PY - 2006/3/16/entrez SP - 170 EP - 5 JF - The British journal of general practice : the journal of the Royal College of General Practitioners JO - Br J Gen Pract VL - 56 IS - 524 N2 - BACKGROUND: Otitis media is the most common reason for children to receive antibiotics, but there is no evidence about the effect of prescribing on reattendance. AIM: To evaluate the changing workload of middle ear disease in general practice, and the impact on surgery reattendance of prescribing antibiotics at first attendance. DESIGN OF STUDY: A case-linked cohort analysis for antibiotic prescribing versus no prescribing at first consultation event. SETTING: Two hundred and ninety-one practices spread throughout the UK recording for the General Practice Research Database (GPRD) and incorporating individual patient data records for 2,265,574 patients. METHOD: All middle ear disease coded events that can be classed within acute otitis media (AOM) or glue ear sub-categories (and excluding chronic suppurative otitis media) were selected for analysis when the first event was from 1991-2001. The effect of antibiotic prescription on the risk of reattendance using Cox proportional hazards regression was analysed. RESULTS: Total consultations for AOM have fallen markedly over this decade, and glue ear consultations have risen but by a much smaller extent (26,000 decrease versus 4000 increase in consultations per year), which makes relabelling an unlikely explanation of the fall in AOM consultations. In the 2-10 years age range, consultations for AOM fell from 105.3 to 34.7 per 1000 per year, with glue ear consultations unaltered (15.2 to 16.7 per 1000 per year). Antibiotic prescribing for AOM has stayed remarkably constant (80-84% of consultations), but antibiotic prescribing for glue ear has risen sharply (13 to 62%). Prescribing antibiotics increased the risk of reattendance for AOM (hazard ratio [HR] = 1.09, 95% confidence interval [CI] = 1.07 to 1.10) and has reduced the risk of reattendance for glue ear (HR = 0.92, 95% CI = 0.88 to 0.96). CONCLUSION: Prescribing antibiotics for AOM probably increased reattendance, but the opposite effect has been noted for glue ear, which suggests a treatment effect of antibiotics in glue ear. Further research is needed to clarify whether this possible benefit is worth the known harms, and if so in which subgroups of children. SN - 0960-1643 UR - https://www.unboundmedicine.com/medline/citation/16536956/Consultations_for_middle_ear_disease_antibiotic_prescribing_and_risk_factors_for_reattendance:_a_case_linked_cohort_study_ L2 - http://bjgp.org/cgi/pmidlookup?view=long&pmid=16536956 DB - PRIME DP - Unbound Medicine ER -