Tuesday, August 14, 2007
Otitis Media- Treat or Watch?
Most parents are heartbroken when they hear their toddler cry with an earache. It is one of the most common reasons for a visit to the pediatrician and most parents expect antibiotic treatment. The American Academy of Pediatricians and the American Academy of Family Practice issued guidelines in 2004 for most cases of acute otitis media (ear infection) and those recommendations call for observation, not treatment.
A new study in Pediatrics reported that over 80% of physicians agree with the guidelines that observation is a reasonable option for acute otitis media. But only 15% of physicians really did it...85% prescribed antibiotics at the visit.
This shows how academic guidelines often don't reflect the real world of patient care. Physicians say that parental reluctance and the cost and difficulty of follow-up for children were the main reasons they prescribed antibiotics.
The same thing goes on in adult medicine all the time. Each patient can present slightly differently and a patient is not a textbook or a study population. The young woman with symptoms of a "cold" who is getting married in 4 days is going to get a prescription from me. The man who is flying to New York for a critical business meeting is going to get a prescription. It may not fit the guidelines, but real patients have complex lives that don't fit into a study. That's why they call it the "art" of medicine.
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