Wait-and-see antibiotic prescription is feasible for treating acute otitis media
- Conrad, Dennis A. MD
BACKGROUND
Otitis media is commonly managed in primary care using antibiotics. Uniform prescription of antibiotics may achieve only marginal benefits. Potential patient side-effects, future expectations for antibiotic prescriptions and increasing antibiotic resistance need to be considered. The implications of using alternative prescription strategies have not been fully evaluated.
OBJECTIVE
Comparison of immediate and delayed antibiotic prescription for acute childhood otitis media.
SETTING
General practices in three Southwest England health authorities; year not specified.
METHOD
Controlled open randomised trial.
LITERATURE REVIEW
No explicit strategy; 28 references.
PARTICIPANTS
Three hundred and fifteen children aged 3 months-10 years displaying standardised symptoms of otitis media recruited by 48 doctors.
INTERVENTION
Treatment using immediate antibiotic prescription strategy or delayed prescription by 72-hours. Differences in group outcomes and potential bias were analysed using student-t and chi-square tests.
OUTCOMES
Symptom duration; patient distress intensity; side-effects; parent satisfaction.
MAIN RESULTS
The daily dosage of paracetamol consumed and mean duration of earache, ear discharge, crying and night disturbance were significantly lower for those receiving immediate antibiotic treatment (P all < 0.01). Diarrhoea was less common in the delayed antibiotics group and parents were less likely to believe in the effectiveness of antibiotics. There was no difference between average daily distress episodes (P = 0.31), school days missed (P = 0.56) or daily pain scores (P = 0.24).
AUTHOR'S CONCLUSIONS
Immediate prescription of antibiotics may reduce the duration of most symptoms; however, most of the benefit occurs after 24 hours, when the illness is already settling. A more discriminatory wait-and-see prescription strategy has fewer side-effects and is acceptable to the majority of parents.