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Journal of Public Health Advance Access originally published online on September 1, 2008
Journal of Public Health 2008 30(4):479-486; doi:10.1093/pubmed/fdn072
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© The Author 2008, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Has UK guidance affected general practitioner antibiotic prescribing for otitis media in children?



P. L. Thompson, PhD Student1

R. E. Gilbert, Professor of Clinical Epidemiology2

P. F. Long, Senior Lecturer in Molecular Microbiology3

S. Saxena, General Practitioner and Senior Lecturer in Primary Care4

M. Sharland, Consultant in Paediatric Infectious Diseases5

I. C. K. Wong, Professor of Paediatric Medicines Research1
1 Centre for Paediatric Pharmacy Research, The School of Pharmacy, University of London, BMA House, Tavistock Square, London WC1H 9JP, UK
2 Centre for Evidence-based Child Health, Institute of Child Health, London WC1N 1EH, UK
3 Department of Pharmaceutics and Centre for Paediatric Pharmacy Research, The School of Pharmacy, 29–39 Brunswick Square, London WC1N 1AX, UK
4 Department of Primary Care and Social Medicine, Imperial College London, London W6 8RP, UK
5 Paediatric Infectious Diseases Unit, St. George's Hospital, London SW17 0RE, UK

Address correspondence to Ian C K Wong, E-mail: ian.wong{at}pharmacy.ac.uk


  Abstract

Background Since 1997, UK guidance has advocated limiting antibiotic prescribing for otitis media. It is not known whether this has influenced general practitioner prescribing practice.

Aims and objectives To investigate the trends in diagnoses and antibiotic prescribing for otitis media in children in relation to guidance.

Methods We used the General Practice Research Database to conduct time-trend analyses of diagnoses and antibiotic prescribing for otitis media in 3 months to 15 years old, between 1990 and 2006.

Results A total of 1 210 237 otitis media episodes were identified in 464 845 children; two-thirds (68%; 818 006) received antibiotics. Twenty-two percent (267 335) were classified as acute, 85% (227 335) of which received antibiotics. Overall, antibiotic prescribing for otitis media declined by 51% between 1995 and 2000. Much of this reduction predated guidance. During this period, prescribing for otitis media coded as acute increased by 22%. Children diagnosed with acute otitis media were more likely to receive antibiotics than otitis media not coded as acute (P < 0.05). From 2000 prescribing plateaued, despite publication of further guidance. Otitis media diagnoses consistently paralleled prescribing.

Conclusions The reduction in antibiotic prescribing for otitis media predated guidance. The simultaneous decrease in prescribing for non-acute otitis media and increase for acute otitis media suggest diagnostic transfer, possibly to justify the decision to treat.

Keywords: children, ear disorders, epidemiology


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