Impact of acute otitis media clinical practice guidelines on antibiotic and
analgesic prescriptions: a systematic review
#MMPMID29502073
Deniz Y
; van Uum RT
; de Hoog MLA
; Schilder AGM
; Damoiseaux RAMJ
; Venekamp RP
Arch Dis Child
2018[Jun]; 103
(6
): 597-602
PMID29502073
show ga
BACKGROUND: Clinical practice guidelines focusing on judicious use of antibiotics
for childhood acute otitis media (AOM) have been introduced in many countries
around the world. OBJECTIVE: To systematically review the effects of these
guidelines on the prescription of antibiotics and analgesics for children with
AOM. METHODS: Systematic searches of PubMed, Embase and Cochrane Library from
inception to 6 June 2017 using broad search terms. Studies specifically aimed at
evaluating the effects of introduction of national AOM practice guidelines on
type of antibiotic and/or analgesic prescriptions were included, irrespective of
design, setting or language. The Risk Of Bias In Non-randomized Studies of
Interventions tool was used to assess risk of bias. RESULTS: Of 411 unique
records retrieved, seven studies conducted in six different countries (France,
Italy, Spain, Sweden, UK and USA (twice)) compared data before and after
guideline introduction. All studies had an observational design, using
longitudinal data of children aged under 15?years (n=200-4.6?million) from either
routine care, insurance databases or electronic surveys. Risk of bias of all
studies was judged serious to critical.Of the five studies reporting on
antibiotic prescription rates, three showed a decline of 5%-12% up to 3 years
after guideline introduction and two found no or negligible effect. In one US
study, the initial 9% decline decreased to 5% after 4-6 years. The recommended
first choice antibiotic was prescribed more frequently (9%-58% increase) after
guideline introduction in four out of five studies reporting on this outcome.
Analgesic prescription rates for AOM were reported in one US study and increased
from 14% to 24% after guideline introduction. CONCLUSION: Based upon what is
published, the effects of introduction of national clinical practice guidelines
on antibiotic and analgesic prescribing for children with AOM seem modest at the
most. REGISTRATION: PROSPERO: CRD42016050976.
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