Analysis of under- and overprescribing of antibiotics in acute otitis media in general practice

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Abstract
Objectives: To assess clinical determinants of under- and overprescribing of antibiotics according to the Dutch national guideline for patients with acute otitis media (AOM) in general practice. Patients and methods: A total of 146 general practitioners (GPs) from the Netherlands included all patients with AOM during a 4 week period in winter, and recorded patient characteristics, clinical presentation and management. Under- and overprescribing of antibiotics in AOM was assessed using the Dutch national guideline. Results: A total of 458 AOM consultations were recorded. In seven out of 10 consultations (310/439; excluding 19 consultations in which patients were referred to secondary care), antibiotic prescribing decisions were according to the national guideline. In 11% of all consultations (50/439), there was underprescribing and in 18% (79/439) there was overprescribing. Patients with an antibiotic indication but without an antibiotic prescription (underprescribing; n = 50) had more short-term symptoms (OR: 0.93), relatively few inflammation signs (OR: 0.47) and were less severely ill (OR: 0.30), compared with patients with an antibiotic indication and an antibiotic prescription (n = 167). Patients without an antibiotic indication but with an antibiotic prescription (overprescribing; n = 79) were more often younger than 24 months (OR: 0.34), more severely ill (OR: 3.30) and expected more often an antibiotic as perceived by their GP (OR: 2.11), compared with patients without an antibiotic indication and without an antibiotic prescription (n = 143). Conclusions: Clinical determinants which are stated as criteria for antibiotic treatment of AOM in the Dutch national guideline were recognized by GPs as important items, but were frequently given too much weight.