Burden of acute otitis media in primary care pediatrics in Italy: a secondary data analysis from the Pedianet database

Abstract

BackgroundThe incidence of acute otitis media (AOM) vary from country to country. Geographical variations together with differences in study designs, reporting and settings play a role. We assessed the incidence of AOM in Italian children seen by primary care paediatricians (PCPs), and described the methods used to diagnose the disease.MethodsThis secondary data analysis from the Pedianet database considered children aged 0 – 6 years between 01/2003 and 12/2007. The AOM episodes were identified and validated by means of patient diaries. Incidence rates/100 person-years (PY) were calculated for total AOM and for single or recurrent AOM.ResultsThe 92,373 children (52.1% males) were followed up for a total of 227,361 PY: 23,039 (24.9%) presented 38,241 episodes of AOM (94.6% single episodes and 5.4% recurrent episodes). The total incidence rate of AOM in the 5-year period was 16.8 episodes per 100 PY (95% CI: 16.7-16.9), including single AOM (15.9 episodes per 100 PY; 95% CI: 15.7-16.1) and recurrent AOM (0.9 episodes per 100 PY; 95% CI: 0.9-0.9). There was a slight and continuously negative trend decrease over time (annual percent change −4.6%; 95%CI: -5.3, -3.9%). The AOM incidence rate varied with age, peaking in children aged 3 to 4 years (22.2 episodes per 100 PY; 95% CI 21.8-22.7). The vast majority of the AOM episodes (36,842/38,241, 96.3%) were diagnosed using a static otoscope; a pneumatic otoscope was used in only 3.7%.ConclusionsOur data fill a gap in our knowledge of the incidence of AOM in Italy, and indicate that AOM represents a considerable burden for the Italian PCP system. Educational programmes concerning the diagnosis of AOM are needed, as are further studies to monitor the incidence in relation to the introduction of wider pneumococcal conjugate vaccines.

Impact of different assumptions on estimates of childhood diseases obtained from health care data: A retrospective cohort study

“…Regarding AOM, there was no difference in incidence when we compared 2 clinically plausible episode durations: 14 versus 30 days; 30 days has been applied in a previous study . Based on the natural history of AOM, the actual duration of an episode is not clear .…”

“…Secondly, the characteristics of childhood diseases present additional challenges; children suffer from mostly common transient infection‐related disease such as acute otitis media (AOM). On the other end of the spectrum of recurrent diseases, there may be rare diseases like acute pyelonephritis (APN) . Diseases that affect children may also be chronic and differ in frequency: asthma is common and chronic unlike type 1 diabetes (DM) which is also chronic but less common .…”

“…On the other end of the spectrum of recurrent diseases, there may be rare diseases like acute pyelonephritis (APN). 7,8 Diseases that affect children may also be chronic and differ in frequency: asthma is common and chronic unlike type 1 diabetes (DM) which is also chronic but less common. 9,10 It would be important to understand the impact of different assumptions on estimates of disease occurrence.…”

Efektywność szczepienia przeciwko pneumokokom a częstość występowania infekcji dróg oddechowych oraz ostrego zapalenia ucha środkowego w populacji zdrowych dzieci w wieku 0–24 miesięcy, w zależności od sposobu ich karmienia

“…Słabe strony: nie badano wpływu palenia tytoniu w środowisku dziecka, sytuacji materialnej rodziny, uczę-szczania do żłobka ani wykształcenia rodziców [15,16].…”

What not to do in acute otitis media: the top five recommendations proposed by the Italian Society of Preventive and Social Pediatrics

“…In Europe, the incidence of AOM in outpatient care is 268 episodes per 1000 people-year (CI 95%: 254-283) (8) and in Italy, in children under 5 years of age, is around 16% (9). Thus, AOM is one of the most frequent indications for antibiotic therapy in children.…”