Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. May 8, 2016; 5(2): 198-205
Published online May 8, 2016. doi: 10.5409/wjcp.v5.i2.198
Parental acceptability of the watchful waiting approach in pediatric acute otitis media
Arnon Broides, Olga Bereza, Noga Lavi-Givon, Yariv Fruchtman, Eli Gazala, Eugene Leibovitz
Arnon Broides, Yariv Fruchtman, Eugene Leibovitz, Pediatric Emergency Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84140, Israel
Olga Bereza, Family Medicine Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84140, Israel
Noga Lavi-Givon, Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84140, Israel
Eli Gazala, Child Health Community Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84140, Israel
Author contributions: Broides A, Bereza O and Leibovitz E contributed to research design, research performing, data analysis, manuscript preparation; Lavi-Givon N contributed to research design, data analysis; Fruchtman Y and Gazala E contributed to research design, research performing, data analysis.
Institutional review board statement: The study was approved by the Institutional Review Board of the Soroka University Medical Center, Beer-Sheva, Israel (protocols WW 001 FROM 02/07/2006).
Informed consent statement: All involved parents gave their informed consent (verbal, as accepted by the hospital Helsinki committee) prior to study inclusion. All details that could disclose the identity of the subjects under study were omitted/anonymized.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at eugenel@bgu.ac.il. Participants gave verbal informed consent for data sharing and the presented data were anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eugene Leibovitz, MD, Professor, Pediatric Emergency Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 1 Rager Blvd, Beer-Sheva 84140, Israel. eugenel@bgu.ac.il
Telephone: +972-8-6232334 Fax: +972-8-6232334
Received: July 26, 2015
Peer-review started: July 27, 2015
First decision: September 22, 2015
Revised: December 26, 2015
Accepted: January 21, 2016
Article in press: January 22, 2016
Published online: May 8, 2016
Abstract

AIM: To determine parental knowledge about acute otitis media (AOM) and its antibiotic therapy, antibiotic resistance and the willingness to comply with the watchful waiting (WW) approach in primary care settings in southern Israel.

METHODS: The study was conducted in 3 primary care clinics and the pediatric emergency room of Soroka University Medical Center. Questionnaires (20 questions on education background, previous AOM experience, knowledge on antimicrobial resistance and attitude vs the WW approach) were filled by 600 parents (150 at each centers) of children < 6 years of age.

RESULTS: Mothers represented 69% of parents; 2% had an education of < 10 school years, 46% had high-school education and 17% had an academic degree. 69% parents reported previous experience with AOM and 56% thought that antibiotics represent the only treatment for AOM. Knowledge on bacterial resistance to antibiotics was reported by 57% of the parents; 86% parents were willing to accept/probably accept the WW approach for their children. Logistic regression analysis revealed a significant association between parental education and knowledge about bacterial resistance to antibiotics and that previous experience with AOM was significantly associated with reluctance to accept the WW approach. More parents with knowledge on bacterial resistance were willing to accept the WW approach compared with parents without such knowledge. No correlation was found between the education level and willingness to accept the WW approach.

CONCLUSION: A significant correlation was found between previous parental education and experience with AOM and the knowledge about antibiotic use, bacterial resistance and acceptance of the WW approach.

Keywords: Acute otitis media, Children, Antibiotics, Parents, Watchful waiting, Bacteria, Resistance

Core tip: The 2004 and 2013 guidelines of the American Academy of Pediatrics suggest the use of a watchful waiting (WW) approach to antibiotic therapy in a selected group of children with acute otitis media (AOM). We determined the parental knowledge about AOM and its antibiotic therapy, antibiotic resistance and the willingness to comply with the WW approach in primary care settings and found a significant correlation between parental education level, previous experience with AOM, knowledge about antibiotic use and about bacterial resistance and the acceptance of the WW approach.