In September of this year, JAMA published a study entitled, “Wait-and-See Prescription for the Treatment of Acute Otitis Media” by David M. Sprio, MD, et al. (JAMA 2006;296:1235–1241). Participants in the study were children between the ages of 6 months and 12 years who were diagnosed in an emergency department with AOM. The participants’ parents were given an antibiotic prescription that would expire three days following the child’s visit to the emergency department. Parents were instructed to fill the prescription if their child was not better, or was worse, 48 hours after their visit to the emergency department. Prescriptions were not filled for 62% of patients. The parents who did fill the prescription reported that they did so because of fever, otalgia, or fussy behavior. Follow-up at 4, 6, 11, and 14 days found that the rates of otalgia were not significantly different between patients who took antibiotics and those who did not. Furthermore, reported rates of diarrhea were two- to threefold higher in patients who took antibiotics immediately compared with patients in the “wait-and-see” group.
In the same issue of JAMA, Paul Little, MD, of the Community Clinical Sciences Division, University of Southampton, Southampton, UK, wrote an editorial on the subject entitled, “Delayed Prescribing—A Sensible Approach to the Management of Acute Otitis Media” (JAMA 2006;296:1290–1291). Dr. Little lists several potential advantages to delayed prescribing of antibiotics:
- Delayed prescribing rationalizes antibiotic use.
- Delayed prescribing changes patient and family beliefs about antibiotics.
- Delayed prescribing achieves acceptable symptom control.
Dr. Little concluded in his editorial that delayed prescribing of antibiotics is a reasonable approach when a child is not systemically ill and the physician has no major concerns about sicker or at-risk patients, including those with systemic symptoms, comorbidity, or those younger than six months. This school of thought is echoed in the American Academy of Pediatrics and American Academy of Family Physicians Clinical Practice Guidelines for Diagnosis and Management of Acute Otitis Media.