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Objectives <p>Acute otitis media is a leading cause of antibiotic prescription in children. Watchful waiting is the preferred strategy for mildly ill children ≥ 2-year-old; however, utilization of this varies. This study aims to evaluate adherence to Canadian Pediatric Society position statement for acute otitis media diagnosis and management in a tertiary pediatric emergency department.</p> Methods <p>We conducted a health records review of children ≥ 2&#xa0;years discharged from emergency department with acute otitis media diagnosis between January and December 2021. Measures of non-adherence were defined as follows: Therapeutic (missed opportunity for watchful waiting, prolonged duration of treatment, lack of immediate treatment when warranted, and inappropriate antibiotic choice), and Diagnostic (diagnostic criteria absent). Additionally, we explored the associations between guideline non-adherence and sociodemographic factors.</p> Results <p>396 patients were included. Guideline non-adherence occurred in 62.6% (248/396) encounters. Within therapeutic non-adherence, the most prevalent category was missed opportunity for watchful waiting in 41.9% (166/396) encounters. Watchful waiting was utilized in only 22% (48/214) of eligible mildly ill cases, 78% (166/214) received prescriptions. Prolonged antibiotic duration occurred in 6.6% (26/396) despite lack of complications and 4.3% (17/396) received non-penicillin antibiotics as first-line treatment. Diagnostic criteria were absent in 21.5% (85/396) encounters. Preferred language, rurality, and Material and Social Deprivation Index demonstrated no significant association with non-adherence, however, was limited by small subgroup sample size.</p> Conclusions <p>62.6% (248/396) of acute otitis media encounters demonstrated guideline non-adherence, primarily through inappropriate antibiotic prescribing and absence of diagnostic criteria. Quality improvement initiatives targeting diagnostic accuracy and watchful waiting implementation represent critical opportunities for antibiotic stewardship.</p>

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Antibiotic treatment of acute otitis media: has watchful waiting gone with the diagnosis?

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Gunjan Mhapankar,
  • Carsten Krueger,
  • Waleed Alqurashi,
  • Ewa Sucha,
  • Richard J. Webster,
  • Jennifer Bowes,
  • Nicole Le Saux

摘要

Objectives

Acute otitis media is a leading cause of antibiotic prescription in children. Watchful waiting is the preferred strategy for mildly ill children ≥ 2-year-old; however, utilization of this varies. This study aims to evaluate adherence to Canadian Pediatric Society position statement for acute otitis media diagnosis and management in a tertiary pediatric emergency department.

Methods

We conducted a health records review of children ≥ 2 years discharged from emergency department with acute otitis media diagnosis between January and December 2021. Measures of non-adherence were defined as follows: Therapeutic (missed opportunity for watchful waiting, prolonged duration of treatment, lack of immediate treatment when warranted, and inappropriate antibiotic choice), and Diagnostic (diagnostic criteria absent). Additionally, we explored the associations between guideline non-adherence and sociodemographic factors.

Results

396 patients were included. Guideline non-adherence occurred in 62.6% (248/396) encounters. Within therapeutic non-adherence, the most prevalent category was missed opportunity for watchful waiting in 41.9% (166/396) encounters. Watchful waiting was utilized in only 22% (48/214) of eligible mildly ill cases, 78% (166/214) received prescriptions. Prolonged antibiotic duration occurred in 6.6% (26/396) despite lack of complications and 4.3% (17/396) received non-penicillin antibiotics as first-line treatment. Diagnostic criteria were absent in 21.5% (85/396) encounters. Preferred language, rurality, and Material and Social Deprivation Index demonstrated no significant association with non-adherence, however, was limited by small subgroup sample size.

Conclusions

62.6% (248/396) of acute otitis media encounters demonstrated guideline non-adherence, primarily through inappropriate antibiotic prescribing and absence of diagnostic criteria. Quality improvement initiatives targeting diagnostic accuracy and watchful waiting implementation represent critical opportunities for antibiotic stewardship.