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Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline.
Pediatrics 2010; 125(2):214-20Ped

Abstract

OBJECTIVES

Observation without initial antibiotic therapy was accepted as an option for acute otitis media (AOM) management in the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline. The guideline also recommended amoxicillin as the first-line treatment for most children, and analgesic treatment to reduce pain if it was present. Our objective was to compare the management of AOM after publication of the 2004 guideline.

PATIENTS AND METHODS

We analyzed the National Ambulatory Medical Care Survey, 2002-2006 (N = 1114), which occurred in US physicians' offices. The patients were children aged 6 months to 12 years who were diagnosed with AOM. The time comparisons were the 30-month periods before and after the guideline. The main outcome was the encounter rate at which no antibiotic-prescribing was reported. Secondary outcomes were the identification of factors associated with encounters at which no antibiotic-prescribing was reported and antibiotic- and analgesic-prescribing rates.

RESULTS

The rate of AOM encounters at which no antibiotic-prescribing was reported did not change after guideline publication (11%-16%; P = .103). Independent predictors of an encounter at which no antibiotic-prescribing was reported were the absence of ear pain, absence of reported fever, and receipt of an analgesic prescription. After guideline publication, the rate of amoxicillin-prescribing increased (40%-49%; P = .039), the rate of amoxicillin/clavulanate-prescribing decreased (23%-16%; P = .043), the rate of cefdinir-prescribing increased (7%-14%; P = .004), and the rate of analgesic-prescribing increased (14%-24%; P = .038).

CONCLUSIONS

Although management of AOM without antibiotics has not increased after the publication of the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline, children who did not receive antibiotics were more likely to have mild infections. In accordance with the guideline, the prescribing of amoxicillin and analgesics has increased. Contrary to the guideline, the prescribing of amoxicillin/clavulanate has decreased, whereas the prescribing of cefdinir has increased.

Authors+Show Affiliations

Lancaster General Hospital, Lancaster General Research Institute, 555 N Duke St, Lancaster, PA 17604, USA. ascoco@lancastergeneral.orgNo 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

20100746

Citation

Coco, Andrew, et al. "Management of Acute Otitis Media After Publication of the 2004 AAP and AAFP Clinical Practice Guideline." Pediatrics, vol. 125, no. 2, 2010, pp. 214-20.
Coco A, Vernacchio L, Horst M, et al. Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline. Pediatrics. 2010;125(2):214-20.
Coco, A., Vernacchio, L., Horst, M., & Anderson, A. (2010). Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline. Pediatrics, 125(2), pp. 214-20. doi:10.1542/peds.2009-1115.
Coco A, et al. Management of Acute Otitis Media After Publication of the 2004 AAP and AAFP Clinical Practice Guideline. Pediatrics. 2010;125(2):214-20. PubMed PMID: 20100746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline. AU - Coco,Andrew, AU - Vernacchio,Louis, AU - Horst,Michael, AU - Anderson,Angela, Y1 - 2010/01/25/ PY - 2010/1/27/entrez PY - 2010/1/27/pubmed PY - 2010/3/5/medline SP - 214 EP - 20 JF - Pediatrics JO - Pediatrics VL - 125 IS - 2 N2 - OBJECTIVES: Observation without initial antibiotic therapy was accepted as an option for acute otitis media (AOM) management in the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline. The guideline also recommended amoxicillin as the first-line treatment for most children, and analgesic treatment to reduce pain if it was present. Our objective was to compare the management of AOM after publication of the 2004 guideline. PATIENTS AND METHODS: We analyzed the National Ambulatory Medical Care Survey, 2002-2006 (N = 1114), which occurred in US physicians' offices. The patients were children aged 6 months to 12 years who were diagnosed with AOM. The time comparisons were the 30-month periods before and after the guideline. The main outcome was the encounter rate at which no antibiotic-prescribing was reported. Secondary outcomes were the identification of factors associated with encounters at which no antibiotic-prescribing was reported and antibiotic- and analgesic-prescribing rates. RESULTS: The rate of AOM encounters at which no antibiotic-prescribing was reported did not change after guideline publication (11%-16%; P = .103). Independent predictors of an encounter at which no antibiotic-prescribing was reported were the absence of ear pain, absence of reported fever, and receipt of an analgesic prescription. After guideline publication, the rate of amoxicillin-prescribing increased (40%-49%; P = .039), the rate of amoxicillin/clavulanate-prescribing decreased (23%-16%; P = .043), the rate of cefdinir-prescribing increased (7%-14%; P = .004), and the rate of analgesic-prescribing increased (14%-24%; P = .038). CONCLUSIONS: Although management of AOM without antibiotics has not increased after the publication of the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline, children who did not receive antibiotics were more likely to have mild infections. In accordance with the guideline, the prescribing of amoxicillin and analgesics has increased. Contrary to the guideline, the prescribing of amoxicillin/clavulanate has decreased, whereas the prescribing of cefdinir has increased. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/20100746/Management_of_acute_otitis_media_after_publication_of_the_2004_AAP_and_AAFP_clinical_practice_guideline_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=20100746 DB - PRIME DP - Unbound Medicine ER -