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Physician specialty is associated with adherence to treatment guidelines for acute otitis media in children



Z Grossman, M.D., Maccabi Health Services, 3 Hausner st., Tel Aviv 69363, Israel.

Tel.: +97252258298 |

Fax: +9723699046 |




To identify physician and visit characteristics affecting adherence to guidelines recommending delayed antibiotic therapy for acute otitis media (AOM).


We used physician visit data from an Israeli health maintenance organization to identify children ages 0–15 diagnosed with AOM. We defined early antibiotic treatment as purchase, within 3 days of diagnosis, of antibiotics prescribed by the diagnosing physician. We considered the effect of physician specialty (paediatrician, otolaryngologist, and family physician), day of the week, setting (urgent care/clinic) and clinic location (peripheral/central) on the rate of early treatment.


Proportion of cases receiving early treatment dropped from 2002 to 2009 in cases treated by otolaryngologists (47–36%) and paediatricians (46–42%) and increased in cases treated by family physicians (43–50%). Treatment rate was higher in cases treated on weekends than on weekdays (48% vs. 44%), in urgent care as compared to clinic settings (51% vs. 44%), and in children living in peripheral as compared to central areas (52% vs. 38%).


Successful implementation of delayed treatment of otitis media guidelines requires addressing factors associated with increased early treatment rates.