Adherence to the Clinical Practice Guidelines for Acute Otitis Media and It’s Relationship to Outcomes

Background and Objectives:OM (Acute otitis media) is one of the most common childhood infections, especially after acute upper respiratory tract infections. It is also the leading cause of clinic’s visits by children, and the most frequent reason doctors prescribe antibiotics. The American Academy of Pediatrics, American Academy of Family Physicians and American Academy of Otorhinolaryngology Head-and-Neck surgery develop a clinical practice guideline for AOM. This evidence-based guideline provides recommendations to clinicians for the management of children from 2 months through 12 years of age with uncomplicated AOM. Our goal is to assess the variability and appropriateness of antibiotics prescribing patterns and also to evaluate the relationships between guideline adherence and prognosis of AOM.ethods:ata source of this study was based on outpatient clinic of Otolaryngology Head-and-Neck surgery department in Taipei Veterans General Hospital from 2005 to 2008. Medical records of children from 2 months through 12 years of age with ICD-9 CM diagnosis code of AOM were reviewed. The adherence of doctors’ prescribing patterns focusing on antibiotics was considered appropriate when in accord with clinical practice guideline for AOM. The study also examines the relationships between guideline adherence and primary control (defined as the eardrum condition at the evaluation point closest to 1~14 days after therapy of antibiotics finished), secondary control (defined was the eardrum condition at the evaluation point closest to 30 days after first visit owing to this episode) of AOM.esults:omplete medical record review was conducted in a total of 207 children, aged mostly from 2 to 6 years old (60.4%). Numbers of the visits were higher in Spring and Autumn (58.5%). Amoxicillin with or without β‐lactamase inhibitor was prescribed to majority of the patients (92.7%). The overall adherence of antibiotics prescription was only 8.2%. Among them, all of the antibiotics “items” fulfill the recommendations of guideline, while the “dosage” was under in 85%. The “duration” of prescribing antibiotics was adherent to guideline in 50.7%. Specialists who had been practicing for more than 20 years have poorer adherence to the guideline (p=0.006). The overall adherence was associated neither with primary nor secondary control of AOM. Better adherence of “dosage” was found to be significantly related to better primary control (p=0.047). As to the prescription containing amoxicillin, theelationship was stronger in children below 20Kg with bilateral AOM (p=0.045). Better adherence of “duration of prescribing antibiotics” was related to better secondary control (p=0.42).