Dr. Zachi Grossman , primary pediatrician, Maccabi Health Services
3 Hausner st. Tel Aviv
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Abstract |
Acute otitis media (AOM) is the most common bacterial infection, and the main reason for antibiotic prescriptions in childhood. In recent years, the therapeutic approach for AOM was reexamined, mainly due to a sharp increase in bacterial resistance to antibiotics. It was shown in many intervention studies comparing antibiotics to placebo, that the majority of patients treated with placebo fully recovered, and the otitis resolved spontaneously without complications. There was only a minor shortening of symptoms in the antibiotic group.
In view or these results, the delayed antibiotic approach was developed, first in the Netherlands and then in other countries. The essence of the new approach is that antibiotic therapy is delayed for a period of 24-72 hours, and symptomatic analgesic therapy is prescribed. Antibiotics are prescribed only if there is deterioration, or no improvement occurs after 72 hours.
Studies examining the new approach proved a 60-70% clinical success and recovery of patients without antibiotics prescribed. Parents reported satisfaction with the new approach. and no complications were reported.
In 2004, new AOM guidelines of The Israel Medical Association were written and distributed to pediatricians, family physicians and otolaryngologists. The guidelines give the physician the option to consider the new approach, provided good explanation to the parents is given, analgesics are prescribed and adequate follow up is assured.
The purpose of the study is to launch an educational effort in one of Maccabi districts to help implement the new guidelines .The intervention will include pediatricians and parents. Physicians will attend a lecture, and educational material will be mailed to physicians and parents. Other Maccabi districts will serve as controls.
The outcome will be the use of a new diagnostic code – “Otits media – delayed antibiotic treatment”, the antibiotic prescriptions and the purchase of antibiotics in the pharmacy.
Decreasing the number of antibiotic prescriptions is an important weapon in the effort to lower bacterial antibiotic resistance. The new approach can also contribute to a change of attitudes of both practitioners and public towards antibiotic therapy in particular, and public health in general.
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