Physicians are not adherent to clinical practice guidelines for acute otitis media

Objectives: To assess the variability, appropriateness of antibiotics prescriptions for children under 12 years of age with acute otitis media and to evaluate physicians' adherence to the current clinical practice guideline.

Methods: This is a retrospective study. Data source of this study was based on outpatient clinic of Otolaryngology Head-and-Neck surgery department in Taipei Veterans General Hospital, a tertiary referral center, from 2005 to 2008. Children 2 months-12 years old presented in our hospital with the diagnosis of uncomplicated acute otitis media were enrolled. Medical records regarding antibiotics prescriptions were reviewed in details. The adherence of physicians' antibiotics prescription was considered appropriate when totally (three aspects: the prescribed items, dosage and days of prescription) in accord with the current clinical practice guideline for acute otitis media. Factors that may influence the adherence were also analyzed.

Results: Complete medical record review was conducted in 207 children. Amoxicillin with or without β-lactamase inhibitor was the most used antibiotics (92.7%). The overall adherence of prescription was 8.2%. All of the prescribed antibiotics "items" fulfill the guideline recommendations, while "dosage" was under in 85%, and "days of prescription" was adherent to guideline in 50.7%. The adherence was not correlated to patient's age, gender, nor single or both ear diseases; but is significantly correlated with specialists' years of experience and their service quantity. The senior specialists or those with higher service quantity are less correspond with the guidelines suggestions (OR 6.49, 95% CI: 1.71-24.66, p=0.006). Prescriptions with "non-amoxicillin" are better in concordance with the guidelines, OR of non-adherence is 0.13 (95% CI: 0.003-0.055, p=0.006).

Conclusions: The antibiotics prescription for children with acute otitis media varied widely among ENT specialists. The overall adherence was 8.2%. The adherence was not correlated to patient's age, gender, single or both ear infection; but significantly inversely correlated with specialists' years of experience and their service quantity.