Acute otitis media - a brief explanation to parents and antibiotic use

Background. Acute otitis media (AOM) is a common self-limiting disease in children. Antibiotic use is controversial. Physicians in the USA and in Israel prescribe antibiotics almost universally, while physicians in other countries report good outcome without any treatment. Parents' expectation is an important factor influencing a physician's decision to prescribe antibiotics. Objectives. Our aim was to assess whether a brief explanation to parents regarding the self-limited nature of AOM and the controversy regarding antibiotic prescription for the disease will influence the parents' decision regarding antibiotics use. Methods. Parents of the children participating in the study in two primary care clinics belonging to HMO-Clalit Health Services (CHS) in the southern district of Israel were randomly assigned to an intervention (44) and control (37) group. The intervention group received the brief explanation. The two groups received prescription for antibiotics. The subjects comprised 81 children aged 3 months to 4 years visiting the family practice clinics and diagnosed with AOM. The rate of antibiotics purchase, using the prescription given and the factors influencing the decision were evaluated. Results. Fewer parents administered antibiotics to their children in the intervention group compared with the control group (37% versus 63%, respectively, P< 0.0001). Mother's education level was the only factor found to be significantly lower in the group that eventually purchased antibiotics (P< 0.05). Conclusions. In children with AOM, a brief explanation by the family physician to the child's parents about the disease and the expected spontaneous recovery could decrease antibiotic use by similar to50%.