Prescribing Patterns and Retreatment Rates in Patients With Otitis Media

T.I. Shireman and K.A. Kelsey

Clin Drug Invest. 2002;22(5) 

In This Article


Current controversies include not only which antibiotic to use, but also whether to prescribe an antibiotic at all in cases of OM.[19,20,21,22,23] The Drug-Resistant Streptococcus Pneumoniae Therapeutic Working Group recommended in 1999 that amoxicillin should continue to be used as first-line therapy.[12] Reviews of clinical trials have shown that antibiotics only resolved symptoms in 12 to 14% of cases of OM.[11,24] Due to increasing microbial resistance worldwide[25] and evidence that untreated OM often resolves without complications,[20,24,26,27] there has been a growing international interest in shifting away from antibiotics,[20,21,28] in favour of careful observation as a first line of treatment. Decreasing antibiotic use had led to a decline in the incidence of penicillin-resistant bacterial infections.[29,30]

We found that amoxicillin and sulfa drugs were still the most effective agents for the treatment of children with OM in terms of reducing retreatment rates. These results are consistent with and strongly support the current national guidelines[12] to choose narrow-spectrum agents like amoxicillin for initial treatment of acute OM. More work is needed to examine the impact of disseminating treatment guidelines for the appropriate treatment of OM. Indeed, a follow-up comparison of 1999 data is currently being conducted that will allow us to capture the impact of the guidelines.