Background Acute otitis media (AOM) is a common cause for antibiotic prescription. Most guidelines endorse abstaining from immediate antibiotic treatment (‘watchful waiting’, WW) in mild–moderate episodes. We studied adherence rates to the latest AOM guidelines (2013), in terms of antibiotic type and prescription options. Methods In this population-based study, AOM episodes were identified in Clalit Health Services-insured children aged 0–10 years between 2011 and 2018, using a data-sharing platform. After identifying the index, prescription and issuing dates for antibiotics for each AOM episode, treatment was categorized as immediate (≤2 days after diagnosis) or WW (antibiotic not prescribed/issued; prescribed ≤2 days after diagnosis but issued on Days 2–7; or prescribed/issued on Days 2–7). Guideline adherence was measured according to age. Results Of the 491 106 episodes, 361 518 (73.6%) were treated with antibiotics. Following the 2013 guidelines, the ratio of episodes in children aged ≤6 months that were adherent (immediate treatment) was higher (OR = 1.22; 95% CI 1.15–1.29; P < 0.001), whereas the adherent episode ratio for children aged 6–24 months and 2–10 years (WW) was lower (OR = 0.87; 95% CI 0.85–0.88 and OR = 0.94; 95% CI 0.92–0.96, respectively; P < 0.001). Antibiotic prescription rates after 2013 for children aged ≤6 months were not different (OR = 1.03; 95% CI 0.96–1.1; P = 0.4), but were higher in children aged 6–24 months and 2–10 years (OR = 1.07; 95% CI 1.05–1.09; P < 0.001 and OR = 1.02; 95% CI 1.01–1.04; P = 0.015, respectively). Amoxicillin was the most common antibiotic, administered in 75.6% of episodes. Azithromycin was most commonly associated with treatment failure (6.6%). Conclusions Improved adherence to the 2013 guidelines was observed only in children aged ≤6 months and over-treatment with antibiotics was still high.

中文翻译：

---

急性中耳炎的抗生素处方政策：我们是否遵循指南？

背景 急性中耳炎 (AOM) 是抗生素处方的常见原因。大多数指南支持在轻度至中度发作时放弃立即抗生素治疗（“观察等待”，WW）。我们研究了最新 AOM 指南 (2013) 在抗生素类型和处方选择方面的依从率。方法 在这项基于人群的研究中，使用数据共享平台在 2011 年至 2018 年期间在 Clalit Health Services 投保的 0-10 岁儿童中确定了 AOM 事件。在确定每次 AOM 发作的抗生素指数、处方和开具日期后，治疗分为立即（诊断后≤2 天）或 WW（未开具/开具抗生素；在诊断后 ≤2 天开具但在第 2-7 天开具） ；或在第 2-7 天规定/签发）。根据年龄测量指南依从性。结果 491 106 次发作中，361 518 人（73.6%）接受了抗生素治疗。根据 2013 年指南，6 个月以下儿童依从性（即刻治疗）的发病率较高（OR = 1.22；95% CI 1.15-1.29；P < 0.001），而 6 岁以下儿童的依从性发病率6-24 个月和 2-10 年 (WW) 较低（OR = 0.87；95% CI 0.85-0.88 和 OR = 0.94；95% CI 0.92-0.96；P < 0.001）。2013 年后≤6 个月儿童的抗生素处方率没有差异（OR = 1.03；95% CI 0.96-1.1；P = 0.4），但 6-24 个月和 2-10 岁儿童的抗生素处方率更高（OR = 1.07 ；95% CI 1.05–1.09；P < 0.001 和 OR = 1.02；95% CI 1.01–1.04；P = 0.015）。阿莫西林是最常见的抗生素，在 75.6% 的发作中使用。阿奇霉素最常与治疗失败相关（6.6%）。结论 仅在 ≤6 个月的儿童中观察到对 2013 年指南的依从性提高，并且抗生素过度治疗的情况仍然很高。