First Line Antibiotics in Acute Otitis Media: Are There Differences Between Specialties?

Date of submission: 14-08-2018 | Date of acceptance: 14-11-2018 | Published: 29-04-2019

Abstract

 Introduction: AOM is the most common diagnosis for the prescription of antibiotics in children. The Portuguese National Health Autority issued a clinical guideline in 2012, updated in 2014, in which it recommends the use of amoxicillin as first-line antibiotic. The option is based on the fact that amoxicillin is the most effective oral antibiotic against the microorganisms with the greatest risk for acute invasive disease, Streptococcus pneumoniae.

Material and Methods: Between July 1^st and December 31^st 2016, we e-mailed a number of Pediatricians, Family Physicians and Otolaringologists a clinical case of AOM in a child, giving five options of antibiotherapy. We analised the results.

Results: We attained 240 answers, 3 eliminated due to computer error. 102 FP (47 specialists), 74 ENT (33 specialists) and 61 Pediatricians (28 specialists). 96,7% of Pediatricians (CI 95%; 100-84,2%; n=58), 77,8% of FP (CI 95% 87,4-68,2%, n=78) and 32,4% of ENT (CI 95% 43,1-21,7%; N=24) prescribe amoxicillin as first line antibiotic. The prescription of amoxicillin is statistically different between ENT and FP (p<0.02) and between ENT and Pediatrics (p<0.01).

Discussion and Conclusion: There are significant differences between specialties concerning the choice for amoxicillin as first line antibiotic. Pediatricians came close to 100% and ENT chose otherwise, preferring Amoxicilin with Clavulanate. This difference may be explained by the bias introduced by the specialty itself (ENT), which generally treats the most complicated cases or the ones resistant to first-line therapy.

Key-words: acute otitis media; antibiotherapy; amoxicilin;