Acute otitis media: habits difficult to lose and adherence to guidelines. Is it time to change?

Key words: Acute otitis media, Antibiotic therapy, Delayed prescription, Guidelines

A recent publication on the prescriptive attitude of American paediatricians towards a child older than two years of age with acute otitis media (OMA) showed that 98% of cases received antibiotic therapy, only in 4.5% of cases administered after “delayed prescription" (persistence or worsening of symptoms 48-72 hours after the onset). In accordance with the guidelines, the first choice drug in 80% of the cases was amoxicillin while the duration of therapy in many cases was longer than the 5 days recommended in the treatment of OMA in this age group. The indications and divergences of the main guidelines on the treatment of the OMA are discussed in the present paper. Guidelines are frequently disregarded in clinical practice, also in Italy, although the numerous studies available confirm their validity. Therefore, it is necessary to define indicators relating to the excessive use of antibiotics to identify specific areas of intervention that should be considered as priorities in punctual antimicrobial stewardship programmes aimed to improve clinical practice.