Background: Acute otitis media (AOM) and pharyngitis are very common infections in children and adolescents.\nItaly is one of the European countries with the highest rate of antibiotic prescriptions. The aim of this study is to\ndescribe first-line treatment approaches for AOM and pharyngitis in primary care settings in Italy over six years,\nincluding the prevalence of â??wait and seeâ?? for AOM, where prescription of antibiotics is delayed 48 h from\npresentation, and differences in prescribing for pharyngitis when diagnostic tests are used.\nMethods: The study is a secondary data analysis using Pedianet, a database including data at outpatient level from\nchildren aged 0-14 in Italy. Prescriptions per antibiotic group, per age group and per calendar year were described\nas percentages. â??Wait and seeâ? approach rate was described for AOM and pharyngitis prescriptions were further\ngrouped according to the diagnostic test performed and test results.\nResults: We identified 120,338 children followed by 125 family pediatricians between January 2010 and December\n2015 for a total of 923,780 person-years of follow-up. Among them 30,394 (mean age 44 months) had at least one\nAOM diagnosis (n = 54,943) and 52,341 (mean age 5 years) had at least one pharyngitis diagnosis (n = 126,098).\n82.5% of AOM diagnoses were treated with an antibiotic within 48 h (mainly amoxicillin and amoxicillin/clavulanate)\nand the â??wait and seeâ? approach was adopted only in 17.5% of cases. The trend over time shows an increase in\nbroad spectrum antibiotic prescriptions in the last year (2015). 79,620 (63%) cases of pharyngitis were treated and\namong GABHS pharyngitis confirmed by rapid test 56% were treated with amoxicillin. The ones not test confirmed\nwere treated mainly with broad spectrum antibiotics.\nConclusions: Despite guidance to use the â??wait and seeâ?? approach in the age group analyzed, this strategy is not\noften used for AOM, as previously noted in other studies in hospital settings. Broad-spectrum antibiotic prescription\nwas more frequent when pharyngitis was not confirmed by rapid test, in keeping with evidence from other studies\nthat diagnostic uncertainty leads to overuse of antibiotics.
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