Low rates of adherence to 1999 acute otitis media treatment guidelines across pediatric and family practices

• Objective: To assess adherence to 1999 guidelines for the treatment of children with acute otitis media (AOM) across primary care specialties and to measure differences across specialties and practice types. • Design: Retrospective record review. • Patients and setting: 723 children aged 6 to 36 months who were diagnosed with suppurative otitis media in 2000 and received care at 1 of 4 primary care practice cohorts (university, community, pediatric, and family practice) within the Duke University Health System. • Results: Adherence to guidelines was seen in 34% of episodes of AOM. Reasons for nonadherence included use of an alternate antimicrobial agent (46%) or suboptimal dosing of amoxicillin or amoxicillin-clavulanate (54%). Pediatricians were more likely than family practitioners to use high-dose amoxicillin or amoxicillin-clavulanate therapy (odds ratio [OR], 8.27; P < 0.001) and to follow treatment guidelines (OR, 3.70; P < 0.001). Guideline adherence was significantly lower in the treatment of children who had received prescriptions for antimicrobials in the past 3 months (OR, 0.58; P = 0.005), were younger than 2 years of age (OR, 0.48; P < 0.001), or had a history of antimicrobial allergy (OR, 0.50; P = 0.03). • Conclusion: Rates of adherence to AOM treatment guidelines were low and varied between types of primary care practices.

Duke Scholars

Author Rowena Joy Dolor Medicine, General Internal Medicine

Author Emmanuel Benjamin Walter Jr. Pediatrics, General Pediatrics and Adolescent Health