Parental expectations that antibiotics will be prescribed for self-limiting childhood complaints are difficult to overcome. It becomes more difficult when antibiotic prescribing practice differs between prescribers and doesn’t always follow best practice guidelines. A recent survey of parents with children in playgroup or childcare in Brisbane showed that knowledge about correct treatment of otitis media was lacking – see below.
Acute otitis media is a common community-acquired infection in young children and most will recover without treatment. For otitis media, a minority of patients gain benefit from antibiotic treatment and whereas adverse events, such as diarrhoea, allergy and candidiasis are relatively frequent. Furthermore, prolonged changes to gut flora (microbiome) following treatment with antibiotics may influence subsequent susceptibility to many diseases including pneumonia, inflammatory bowel disease and may also be associated with weight gain. These considerations definitely weight the risk-benefit equation toward avoidance of antibiotic treatment of potentially self-limited or viral childhood respiratory illness. Indeed, Therapeutic Guideline: Antibiotic recommends avoiding the routine use of antibiotics for otitis media and supports the use of delayed prescriptions for patients not responding within 48-72 hrs to symptomatic management.
The National Prescribing Service Resistance Fighter campaigns, which have a very visible social media presence, are trying to reduce the community perception that antibiotics are always required.
15 mothers were interviewed as part of the survey with 12 having tertiary education and 4 a health professional qualification. All were assessed as having a reading level above year 9. Most consulted a GP for ‘ear aches’ for reassurance and due to concerns the infection could become more serious and that the child’s hearing could be affected. Most thought that antibiotics were the only option for treatment and 12 out of 15 had received an antibiotic prescription at the last GP consult for ‘otitis media’. In addition 1 parent had received a delayed prescription while 2 had received no antibiotics. Parents felt that antibiotics would result in a faster recovery and that symptomatic treatment with paracetamol or ibuprofen were not acceptable on their own. Reassuringly all the parent trusted their GPs advice, suggesting an opportunity to intervene and educate when parents present with children suffering otitis media.