Otitis media, tympanostomy tube placement, and use of antibiotics

Objective. To investigate potential links between antimicrobial drug use for acute otitis media (AOM) and tympanostomy tube placements, and the relationship between parental views and physician antimicrobial prescribing habits. Design. Cross-sectional community study repeated after five years. Subjects. Representative samples of children aged 1 - 6 years in four well-defined communities in Iceland, examined in 2003 ( n = 889) and 1998 ( n = 804). Main outcome measures. Prevalence of antimicrobial treatments for AOM, tympanostomy tube placements, and parental expectations of antimicrobial treatment. Results. Tympanostomy tubes had been placed at some time in 34% of children in 2003, as compared with 30% in 1998. A statistically significant association was found between tympanostomy tube placement rate and antimicrobial use for AOM in 2003. In the area where antimicrobial use for AOM was lowest in 1998, drug use had further diminished significantly. At the same time, the prevalence of tympanostomy tube placements had diminished from 26% to 17%. Tube placements had increased significantly, from 35% to 44%, in the area where antimicrobial use for AOM was highest. Parents in the area where antimicrobial consumption was lowest and narrow spectrum antimicrobials were most often used were less likely to be in favour of antimicrobial treatment. Conclusions. Comparison between communities showed a positive correlation between antimicrobial use for AOM and tympanostomy tube placements. The study supports a restrictive policy in relation to prescriptions of antibiotics for AOM. It also indicates that well-informed parents predict a restrictive prescription policy.