Point-of-Prescription Intervention to Improve the Choice of Antibiotic in Acute Otitis Media in Children

  • Paulo Oom Hospital
  • Sofia Lima
  • Ana Escaria
  • Daniela Duarte


Introduction: Antibiotic misuse is a serious problem and is directly related to the increase of bacterial resistance. Antimicrobial stewardship programmes can have a significant impact on the choice of antibiotic. This study evaluated the impact of a simple intervention on antibiotic prescribing for acute otitis media in the paediatric emergency department.

Methods: Prospective study that included all the children admitted to the emergency department for a year. The intervention consisted in placing a warning with information about the recommended antibiotic in children with the diagnosis of acute otitis media. The prescription of antibiotics in this disease was monitored before, during and after the intervention in different age groups and for several professional groups.

Results: During the study period, a diagnosis of acute otitis media was made in 5,695 children. The percentage of amoxicillin prescription increased significantly after the intervention. This increase occurred mainly due to an increase in prescription by paediatricians especially in the 6 months to 2 years age group. The percentage of amoxicillin prescription was lower in the group of general practitioners than in other groups (p < 0.01). These professionals significantly increased the percentage of amoxicillin prescription during the intervention, but it returned to the previous values after the intervention.

Discussion: A very simple measure can have a significant impact on the type of antibiotic prescribed in a paediatric emergency department. The impact of antimicrobial stewardship programs may be not the same for different professional groups. These programs should be maintained over time, otherwise their results may be lost.


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