Pattern of antimicrobial drug prescribing and prescriptive behaviour for acute otitis media among physicians in Sicily

Acute otitis media (AOM) is one of the most common diseases of childhood, but it is less common in adults. Usually, in clinical practice therapy cannot wait until the laboratory report and the choice of an antibiotic prescription is initiated on an empirical basis. Moreover, several studies have shown great variability in antibiotic prescription for AOM. The study was carried out in order to describe the antibiotic prescribing pattern and the prescriptive behaviour among Sicilian general practitioners (GPs) in choosing an empirical antibiotic regimen for treatment of AOM. Each GP completed a questionnaire for each therapeutic intervention which ended with an antibiotic prescription. Diagnoses and drugs were classified according to the International Classification of Diseases (ICD-10) and to the Anatomical Therapeutic Chemical (ATC) classification system, respectively. Antibiotics, issued for AOM, accounted for 11.1% of total antimicrobial therapy in paediatrics and 3.4% in adults. The commonest therapeutic groups were: cephalosporins (44.1%), macrolides (26.1%), extended spectrum penicillins (16.1%), combination of penicillins and beta-lactamase inhibitors (11.4%). The route of administration appeared to be influenced by age of the patients, by a subjective clinical assessment of disease severity and by the presence of concurrent diseases. The diagnostic criteria and the marked variation in antibiotic prescribing pattern for AOM among Sicilian GPs reflects a lack of knowledge of any local or national guidelines