Otitis media across nine countries: Disease burden and management

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Abstract

Objective

To assess the perceived disease burden and management of otitis media (OM) among an international cohort of experienced physicians.

Methods

A cross-sectional survey conducted in France, Germany, Spain, Poland, Argentina, Mexico, South Korea, Thailand and Saudi Arabia. Face-to-face interviews conducted with 1800 physicians (95% paediatricians, 5% family practitioners).Main outcome measures were the perceived burden on clinical practice (number of cases, complications and referrals) and first- and second-line management strategies for OM. Results are expressed as mean and range across the nine countries over three continents.

Results

Respondents estimated an average annual caseload of 375 (range 128–1003) children under 5 years of age with OM; 54% (range 44–71%) with an initial episode and 38% (range 27–54%) with recurrent OM (ROM). OM with complications was estimated to be approximately 20 (range 7–49) cases per year and an estimated 15% (8–41%) of children with OM was recalled as needing specialist referral.

There was high awareness of Streptococcus pneumoniae and Haemophilus influenzae as causative bacterial pathogens: 77% (range 65–91%) and 74% (range 68–83%), respectively, but less recognition of non-typeable H. influenzae (NTHi); 59% (range 45–67%).

Although concern over antimicrobial resistance was widespread, empirical treatment with antibiotics was the most common first-line treatment (mean 81%, range 40–96%). The burden of disease is substantial enough that many physicians would consider vaccination to prevent OM (mean score 5.1, range 4.3–6.2 on 1–7 scale).

Conclusions

This large, multinational survey shows that OM remains a significant burden for clinical practice. Despite awareness of shortcomings, antimicrobial therapy remains the most frequent treatment for OM.

Introduction

Otitis media (OM) is one of the most common childhood illnesses for which medical advice is sought [1], [2], [3]. It encompasses a spectrum of conditions, including acute otitis media (AOM), OM with persistent effusion (OME), recurrent OM (ROM), and chronic suppurative OM (CSOM) [1], [4]. AOM may be associated with considerable distress for the child, including otalgia, fever and malaise, whilst persistent middle ear effusion (MEF) can cause conductive hearing loss and may be associated with delays in speech development and behavioural changes [1], [4].

Approximately 10% of children will experience an episode of AOM by 3 months of age [5] and by 3 years of age, 75% of children will have suffered from at least one acute attack and up to one-third will have experienced recurrent infections [1]. In addition, AOM is one of the primary indications for antibiotic prescription in children aged <3 years and OME is the most common reason for surgery [6], [7], [8].

As a consequence, OM places a considerable disease burden on primary healthcare physicians and specialists [1], [2], [3] and distress for children and their families/caregivers [9], [10], [11], as well as causing significant economic costs, both direct (including physician visits, prescriptions, and surgery) and indirect (including lost income, reduced productivity, and travel costs) [12], [13].

Non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are the two main causes of bacterial OM [14], [15], [16], [17].

There is currently no worldwide consensus on the treatment of OM [5]. Both diagnostic criteria for OM and recommended treatment strategies vary from country to country [5], [18], [19], [20], [21], [22].

Whilst many publications have assessed different aspects of the burden and management of OM, these have primarily been conducted within a single country. This large cross-sectional survey evaluated the perception and knowledge of primary care physicians (PCPs), across nine countries, covering Europe, Latin America, Asia and the Middle East, in terms of the incidence, burden, diagnosis, treatment, and definition of otitis media and compared these results with the published literature and current treatment recommendations.

Section snippets

Methods

This cross-sectional survey of physicians was performed in nine countries worldwide between October and November 2006. A pre-tested questionnaire was completed, during a 40 min face-to-face interview, with 1800 physicians. The sample comprised 200 paediatricians from each of Germany, Spain, Poland, Argentina, Mexico, South Korea, Thailand and Saudi Arabia and 100 paediatricians and 100 family practitioners from France, reflecting first-line clinical practice in these countries (n = 1800, i.e., 95%

Physicians sampled

Of the 1800 physicians participating in the survey, 1700 (95%) were paediatricians, and 1297 (72%) had been in clinical practice for >14 years (Table 1).

Case load

OM was reported as the most prevalent clinical syndrome, of those listed in the questionnaire, in all nine countries (Table 2). The physicians surveyed estimated they each saw on average 375 children, less than five years of age, with non-complicated OM annually (Table 2).

The physicians estimated that 54% (range 44–71%) of children with OM

Discussion

This survey is the first to report on the international variation in both physicians’ perception of the disease burden and the management of OM. The data were obtained from a large sample of 1800 primary care physicians (95% paediatricians and 5% family practitioners) from nine countries, covering Europe, Latin America, Asia and the Middle East.

The study has a number of limitations. The data are based on physicians’ recall rather than chart review. To estimate the number of patient visits and

Conclusion

This survey of 1800 physicians from nine countries demonstrated that OM is perceived to have a substantial burden for clinical practice, with particular regard to ROM and OM with other complications.

OM in children under 5 years of age was primarily treated empirically with antibiotics by physicians in seven out of the nine countries surveyed, despite increasing recommendations for first-line “watchful waiting”/symptomatic treatment in selected children. This indicates that initial observation

Funding

The data of survey were collected and analysed by GfK HealthCare on behalf of GlaxoSmithKline Biologicals. Manuscript development was also funded by GlaxoSmithKline Biologicals.

Conflict of interest statement

Professor Adriano Arguedas: Research grants from GSK, Wyeth, Novartis, Pfizer, Merck, Replidyne, BMS, Biomed. Advisory Boards: GSK, Wyeth, Pfizer, Replidyne and BMS. Honorarium as a speaker: GSK, Wyeth, Pfizer, BMS.

Dr Kari Kvaerner: None.

Professor Dr Johannes Liese: Research grants from GSK, Novartis, Sanofi Pasteur. Advisory Boards: GSK, Abbott, Novartis, Sanofi Pasteur. Honorarium as a speaker: GSK, Wyeth, Sanofi, Abbott, Novartis.

Dr Anne Schilder: Honorarium as a speaker: GSK.

Dr Stephen

Acknowledgements

We thank Dr J Wilson (LiveWire) who provided medical writing services on behalf of GlaxoSmithKline Biologicals, and Dr F Sallmann and Dr J Wilson (GSK Biologicals and LiveWire) for publication coordination. We also thank Dr F Fierens and Dr C Lefebvre (GlaxoSmithKline Biologicals) for their editorial support and Dr Véronique Mouton and Dr Valentine Wascotte (GlaxoSmithKline Biologicals) for coordination support.

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