Antibiotic use and adherence to Finnish treatment guidelines in pediatric acute otitis media

Finnish guidelines recommend antimicrobial treatment for acute otitis media (AOM), with both amoxicillin and amoxicillin-clavulanate as equally acceptable first-line treatment options. This study aimed to investigate in what proportion different antimicrobial agents are prescribed for children with AOM. Our hypothesis was that amoxicillin is the most frequently prescribed antimicrobial agent. This register-based cohort study included all children less than 16 years of age with a diagnosis of AOM in two Finnish hospitals in 2023. Data on children's demographics, AOM symptoms, findings and treatment were collected individually from the patient charts. The primary outcome was the proportion of children who were prescribed amoxicillin, amoxicillin-clavulanate, or other antimicrobial agents for the treatment of AOM. The antimicrobial treatment choices and durations were compared between Turku and Vaasa and reported as percentage differences with 95% confidence intervals. A total of 1,240 children in Turku and 393 children in Vaasa were included in this study. Among these, 80.9% (1,003/1,240) and 80.7% (317/393) were prescribed amoxicillin for the treatment of AOM in Turku and Vaasa, respectively. Amoxicillin-clavulanate was the second most used antimicrobial treatment, prescribed to 10.1% (125/1,240) and 8.7% (34/393) of the children in Turku and Vaasa, respectively. Most of the children with AOM were prescribed a short 5-day course of treatment. CONCLUSION: A short 5-day course of amoxicillin was the most frequently prescribed antimicrobial treatment for children with AOM. The adherence to AOM guidelines appears to be high in the two hospitals studied. WHAT IS KNOWN: • Amoxicillin and amoxicillin-clavulanate are recommended as first-line treatments for acute otitis media in Finland. • National data on real-world antibiotic choices have been limited. WHAT IS NEW: • Amoxicillin was the most frequently prescribed antibiotic in the two Finnish hospitals studied. • The most common treatment duration was a short 5-day course of treatment.