Impact of 2011 French guidelines on antibiotic prescription for acute otitis media in infants

Med Mal Infect. 2014 Mar;44(3):102-6. doi: 10.1016/j.medmal.2014.01.005. Epub 2014 Mar 11.


Objective: In 2011, new guidelines on antibiotic prescription for acute otitis media (AOM) were published in France to decrease the use of third generation cephalosporins that promote the carriage of extended-spectrum beta-lactamase producing Escherichia coli. Our objective was to assess the impact of the 2011 French recommendations on the type of antibiotics prescribed for AOM.

Methods: Fourteen thousand six hundred and sixty-one children, 6 to 24 months of age, presenting with AOM were included in 2 studies, between November 1, 2009 and October 31, 2012. The first one was conducted with the support of 62 private practice pediatricians; the second one was conducted in 7 pediatric emergency departments. Three periods of 1 year each were defined.

Results: Antibiotics were prescribed in 12,471 (85.1%) of cases of AOM during the study period. Amoxicillin prescriptions was multiplied by 25, between the first year (2.6%) and the last year (66.1%). Conversely, prescriptions of cefpodoxime proxetil and amoxicillin-clavulanic acid decreased from 33.6% and 62.0% in the first year to 5.2% and 27.7% in the last year, respectively. This trend was observed in both private practices and in the pediatric emergency departments.

Conclusion: Amoxicillin became the most frequently prescribed antibiotic for AOM in 2012, complying with the 2011 French guidelines, while the proportion of prescribed broad-spectrum antibiotics decreased. Our study highlights the importance of guidelines to decrease the prescription of broad-spectrum antibiotics, a crucial factor in the prevention of antibiotic resistance.

Keywords: Acute otitis media; Antibiotics; Antibiotiques; Otites moyennes aiguës; Pediatric emergency department; Urgences pédiatriques.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Amoxicillin / administration & dosage
  • Amoxicillin / adverse effects
  • Amoxicillin / therapeutic use
  • Amoxicillin-Potassium Clavulanate Combination / therapeutic use
  • Anti-Bacterial Agents / therapeutic use*
  • Ceftizoxime / analogs & derivatives
  • Ceftizoxime / therapeutic use
  • Child, Preschool
  • Drug Resistance, Microbial
  • Drug Utilization / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • France
  • Guideline Adherence
  • Humans
  • Inappropriate Prescribing / prevention & control
  • Inappropriate Prescribing / statistics & numerical data
  • Infant
  • Multicenter Studies as Topic / statistics & numerical data
  • Otitis Media / drug therapy*
  • Pediatrics / statistics & numerical data
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Practice Patterns, Physicians' / trends
  • Private Practice / statistics & numerical data


  • Anti-Bacterial Agents
  • cefpodoxime proxetil
  • Amoxicillin-Potassium Clavulanate Combination
  • Amoxicillin
  • Ceftizoxime