A Clinical Audit: Acute Otitis Media in Children Under the Age of Twelve in a Primary Level Clinic in San Jose, Costa Rica

Context Acute otitis media is one of the most common childhood conditions seen in primary care clinics, and accounts for the majority of antibiotic prescriptions written for children. As the spontaneous resolution of this condition in uncomplicated cases is extremely high, a watch and wait approach to antibiotic therapy has been recommended by many. Benefits of this method include decreased cost, decreased incidence of adverse events, increased patient compliance with treatment, and decreased risk of antibiotic resistance. Re-evaluation of the treatment of acute otitis media therefore has the potential to reduce unnecessary antibiotic prescriptions and thereby reduce the number of adverse events and reduce the threat of antibiotic resistance. Objective To assess the adherence to the recommended evidence-based clinical guidelines for the care for children with acute otitis media in the E.B.A.LS. Los Cuadros and provide a basis for which to make recommendations for improved care. Design A prospective survey. Setting This study was completed at a primary level clinic in the Goicoechea canton of the Purral district of San Jose, Costa Rica; analysis was completed using an SPSS database. Subjects Adults presenting with children between 6/15/05 and 7/15/05 diagnosed with acute otitis media that met the stated inclusion criteria. Main Outcome Measures Rate of treatment with antibiotics, analgesia, both, or no treatment. Results 100% of children diagnosed with acute otitis media received a prescription for an antibiotic, regardless of the status of vomiting and/or fever. 71.4% of the patients received both an antibiotic and acetaminophen, 29% received an antibiotic only, 0% received acetaminophen only, and 0% received no treatment. Conclusions The physicians at the E.B.A.I.S. Los Cuadros are not following the recommended evidence based clinical guidelines for the treatment of acute otitis media. Improved education on evidence-based medicine in general, and the recommended treatment of acute otitis media would be of benefit to this clinic and the patients that are treated there