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Implementing the Delayed Antibiotic Therapy Approach Significantly Reduced Antibiotics Consumption in Israeli Children With First Documented Acute Otitis Media

Grossman, Zachi MD*; Silverman, Barbara G. MD, MPH*; Porter, Boaz MD*; Miron, Dan MD

The Pediatric Infectious Disease Journal: July 2010 - Volume 29 - Issue 7 - p 595-599
doi: 10.1097/INF.0b013e3181d7625e
Original Studies

Background: In 2004, the Israel Medical Association issued guidelines recommending delaying antibiotic therapy for nonsevere acute otitis media (AOM) in children aged ≥6 months for 24 to 48 hours, using analgesics for symptomatic relief instead. We assessed the effect of these guidelines on antibiotic use associated with AOM in an Israeli health maintenance organization.

Methods: We conducted a retrospective study of pharmacy purchasing and physician visit data between the years 2002 and 2007. The study population included children aged 6 months to 5 years who were diagnosed with a first episode of AOM and had not been treated with antibiotics within the proceeding month. For each calendar year data we analyzed the following: (1) annual incidence of first episode of AOM, (2) rate of antibiotic treatment, and (3) rate of topical treatment for pain relief. Comparisons were made among the years for the total population and for age groups 0.5 to 1, 1 to 2, and 2 to 5 years.

Results: The eligible study population ranged from 154,961 children in 2002 to 158,971 in 2007. Between 2002 and 2004, the rate of antibiotic treatment for first documented AOM increased from 53% to 61% in children aged 6 months to 1 year, 56% to 63% among children aged 1 to 2 years, and 51% to 56% of children aged 2 to 5 years (P < 0.001). Between 2004 and 2007, treatment rates decreased from 61% to 54%, 63% to 54%, and 56% to 47%, respectively (P < 0.001). Proportions of cases treated exclusively with topical therapy increased between 2004 and 2007 from 5% to 9%, 4% to 8%, and 8 to 14% for the respective categories (P < 0.001).

Conclusions: Implementation of the delayed antibiotic treatment approach was associated with a significant reduction in use of antibiotics associated with first documented AOM in children aged 6 months to 5 years, reversing an upward trend that occurred previously.


From the *Pediatric Clinic, Maccabi Health Services, Tel Aviv, Israel; and †Pediatric Infectious Consultation Service, HaEmek Medical Center, Afula, Rappaport School of Medicine, Haifa, Israel.

Accepted for publication January 15, 2010.

Address for correspondence: Zachi Grossman, MD, 3 Hausner St, Tel Aviv 69372, Israel. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.