Survey of Indian pediatricians: Clinic-prevalence, diagnostic and management strategies for acute otitis media

ObjectiveAcute otitis media (AOM) is common in Indian children but there is limited published information on its prevalence, and the diagnostic and management practices followed by pediatricians. Such information was collected by surveying pediatricians across four regions of India.MethodBetween May 2010 and February 2011, the same set of pediatricians practicing across north, south, east and west regions of India completed the survey once each during summer, monsoon and winter, using a validated 40-item questionnaire to record their reflective recall. AOM was defined as a ‘congested, bulging tympanic membrane’ (otoscopic diagnosis) for the purpose of this survey.ResultsAmong the 509 respondents, 278 (55%) routinely used otoscopy to diagnose AOM and the data from them was further analyzed. The clinic-prevalence of AOM was 35% with peaks reported in July and December. Eighty two percent (229/278) pediatricians treated AOM with an antibiotic at initial consultation: amoxicillin/clavulanate 85% (237/278), amoxicillin 40% (110/278), azithromycin 29% (80/278), cefixime 19% (53/278) and cefpodoxime 17% (47/278). Amoxicillin/clavulanate 35% (96/278) and cefpodoxime 22% (62/278) were mostly prescribed for relapse. The average reported duration of initial antibiotic therapy was 8 days and for relapse it was 10 days. Eighty six percent of respondents (238/278) prescribed analgesics, and 82% (228/278) prescribed decongestants.ConclusionsThe reported perceived clinic-prevalence of AOM was higher (35%) than anticipated (about 10%) in pediatric practice. More than half of the clinicians surveyed used otoscopy to diagnose AOM, and majority of the respondents who diagnosed AOM otoscopically opted to use an antibiotic at presentation. Amoxicillin/clavulanic acid was the preferred antibiotic for treating acute otitis media. Most pediatricians also used analgesics and decongestants for symptomatic relief.