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A Prospective Observational Study in Primary Care

Federico Marchetti, MD; Luca Ronfani, MD; Sergio Conti Nibali, MD; Giorgio Tamburlini, MD, PhD; for the Italian Study Group on Acute Otitis Media

Arch Pediatr Adolesc Med. 2005;159:679-684.

Objectives  To evaluate the applicability and the effectiveness of practice guidelines based on a wait-and-see strategy for children with acute otitis media (AOM).

Population  Children from 1 to 14 years old having AOM who were referred to primary care pediatric practices.

Study Design  Prospective observational study.

Main Outcome Measure  Proportion of children having a diagnosis of AOM and eligible for symptomatic treatment who, at 72 hours from enrollment, recovered from their symptoms (fever and earache) without receiving antibiotic treatment.

Results  One hundred sixty-nine pediatricians participated in the study and enrolled 1672 children. One thousand two hundred seventy-seven children were included in the analysis. One hundred seventy-eight children received antibiotic treatment at first contact according to the practice guidelines criteria (presence of otorrhea or recurrent AOM). Of the 1099 children who were eligible for symptomatic treatment only, 743 (67.6%) recovered without antibiotic treatment at 3 days and 716 (65.1%) at 30 days. No complications were observed. Coexistence of a high fever (temperature 38.4°C) and red and bulging tympanic membrane as well as male sex were significantly associated with antibiotic use.

Conclusions  Practice guidelines based on a wait-and-see strategy for children with AOM are applicable and effective in primary care. This strategy was able to avoid the administration of antibiotic treatment in 2 of 3 children.

Author Affiliations: Department of Pediatrics and Epidemiology Unit, Institute of Child Health, IRCCS Burlo Garofolo (Drs Marchetti, Ronfani, and Tamburlini), and the Center for Child Health (Dr Ronfani), Trieste, Italy. Dr Nibali is in private practice in Messina, Italy.

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