Huisartsen volgen de herziene NHG-Standaard OMA

Van Hamburg MA, Rovers MM, Kuyvenhoven MM, Verheij ThJM, Van der Velden AW. Dutch general practitioners comply with the revised guideline acute otitis media. Huisarts Wet 2012;55(1):10-13.

Background Dutch primary care has over 100 practical evidence-based treatment guidelines. The second revised guideline for Acute Otitis Media (AOM) was published in 2006.⁴ Antibiotics are indicated for children with AOM younger than 6 months, with severe or exacerbating illness, or with increased risk of complications. New in this guideline are groups of children for whom antibiotics can be considered: children younger than 2 years with bilateral otitis media, children with a discharging ear at first presentation (meta-analysis showed that these subgroups benefit more than others from antibiotics)⁹, and children with symptoms lasting longer than 3 days.¹⁰

Aim To investigate whether general practitioners (GPs) comply with the revised guideline AOM.

Methods Insight in GPs’ prescribing behaviour was obtained by mirroring 198 detailed described consultations involving children with AOM to the revised guideline.

Results Antibiotics were prescribed to 55% of patients with AOM, amoxicillin in 83.5% of prescriptions. Over-prescription (prescribed when not indicated) and under-prescription (not prescribed when indicated) were very rare; the guideline was followed in 96% of the consultations. However, most of the children (60%) fell in the category ‘antibiotics can be considered’, which gives GPs the choice of whether to prescribe or not. There was consensus regarding the GPs’ treatment decisions in this category: fever and bilateral otitis (irrespective of age) in particular led to the prescription of antibiotics.

Conclusion The second revised guideline AOM is adhered to in Dutch primary care. However, due to inclusion of the category ‘consider antibiotics’ the guideline does not provide a clear treatment advice for the majority of patients presenting with AOM in Dutch primary care. As resistance problems are globally increasing, prudent use of antibiotics lists high on the international agenda. To decrease prescription of antibiotics for children, defining a more specific evidence-based prescribing advice for AOM remains necessary, and will provide more clarity for physicians and parents.