Optimizing Patient Care

Antibiotic E-Newsletter

Issue I - 05.2017

In This Issue...

  1. Optimizing Patient Care
  2. Antibiotic Stewardship
  3. AOM Recommendations
  4. AOM Guidelines
  5. AOM Implementations
  6. AOM Resources

Optimizing Patient Care: Antibiotic Stewardship

"We must be diligent stewards of antibiotics, protecting this precious resource in doctor's offices, homes, and farms, so that they are available to help us, and our children, in the future."
- Tom Frieden, MD, MPH, Director, Centers for Disease Control and Prevention


Optimizing Patient Care: Incorporating "Choosing Wisely®" Recommendations into Practice

The IAFP is pleased to announce a new e-newsletter series regarding incorporating "Choosing Wisely®" recommendations into practice. Each newsletter will have a specific focus, with the first being Antibiotic Stewardship. This issue, along with each subsequent e-newsletter, will contain recommendations, updates, links to resources, and strategies for you to implement in your practice.

This newsletter was created by the Illinois Academy of Family Physicians and is made possible by funds received from:

  • American Academy of Family Physicians through its program, The Family Medicine Philanthropic Consortium
  • Blue Cross and Blue Shield of Illinois
  • The Telligen Community Initiative

Online Education Videos

 In addition to the e-newsletter series, IAFP now has two online enduring educational offerings:

  • Optimizing Patient Care. The first being Optimizing Patient Care: Incorporating "Choosing Wisely®" Into Practice
  • Optimizing Patient Care: Antibiotic Stewardship

Visit IAFP's Education website today to learn more!

Antibiotic Stewardship

Antibiotics are among the most commonly prescribed drugs in human medicine. Among antibiotics, azithromycin and amoxicillin are the two prescribed most often. In the outpatient setting each year, 262.5 million courses of antibiotics are prescribed, which amounts to about 5 prescriptions for every 6 people. Of these prescriptions, approximately 50% are either unnecessary or not optimally effective.

Resistance to antibiotics is a threat to public health. The main contributing factor to antibiotic resistance is the misuse and abuse of antibiotics. Annually in the U.S., about 2 million people acquire bacterial infections that are resistant to one or more antibiotics designed to treat those infections. Of those, about 23,000 die.


The loss of effective antibiotics leaves physicians without a means to properly treat infections diseases and infections complications in patients with other diseases. The success of organ transplants, cancer therapies and other medical treatments depends on antibiotics to fight infections. Implementing recommendations for antibiotic use in practice is critical to the continued effectiveness of antibiotics in the future.

Acute Otitis Media (AOM) in Children: Recommendations

Among children in the U.S., the infection for which antibiotics are most commonly prescribed is Acute Otitis Media (AOM). The following are recommendations for antibiotic use (or-non use) in the treatment of AOM.


Choosing Wisely® Antibiotics Recommendation for Otitis Media

Don't prescribe antibiotics for Otitis Media in children aged 2-12 years with non-severe symptoms where the observation option is reasonable.

  • The "observation option" refers to deferring antibacterial treatment of selected children for 48 to 72 hours and limiting management to symptomatic relief.
  • The decision to observe or treat is based on the child's age, diagnostic certainty, and illness severity. To observe a child without initial antibacterial therapy, it is important that the parent or caregiver has a ready means of communicating with the clinician. There also must be a system in place that permits reevaluation of the child.

Prescribe antibiotics for Otitis Media if:

  • Patients are age six months or younger;
  • Patients are between the ages of 6 months and two years and have moderate to severe ear pain; or
  • Patients are age two or older with severe symptoms.

The Choosing Wisely® website also provides Additional Recommendations for reducing Antibiotic use for other conditions, such as respiratory illness.

AOM in Children: Guidelines

AAP/AAFP Guidline on Acute Otitis Media

In July 2013, the AAFP endorsed an updated version of the 2004 AAP/AAFP guideline entitled The Diagnosis and Management of Acute Otitis Media. The 2013 guideline includes 3 action statements on diagnosis and 8 action statements on medical management of AOM in children ages 6 months to 12 years of age.

Evidence-based Guidelines and Recommendations

As part of the Choosing Wisely® campaign, over 50 medical societies have developed more than 250 evidence-based recommendations to support the communication between physician and patient regarding the necessity of specific tests and procedures. Approved by the AAFP, the Choosing Wisely® AOM guideline and recommendations were informed by a systematic review of relevant scientific literature, sources for which included Cochrane Collaboration and the Agency for Healthcare Research and Quality. Additional information on the development of the AOM guideline can be found in the article entitled The Top 5 Lists in Primary Care: Meeting the Responsibility of Professionalism.

AOM in Children: Implementations

Implementation of AOM Recommendations in Practice

Research has shown that recommendations for the medical management of AOM are being followed, but barriers to full implementation still exist. One study found overall adherence to recommendations was between 70-90 percent (70% adherence to dosage and 90% adherence to duration).  A 2007 study of primary care physicians' implementation of the 2004 recommendations on AOM found that among 299 physicians, 83.8% considered the "observation option"(deferring antibiotic treatment for 48-72 hours in some children, based on age, diagnosis and severity of illness), to be a reasonable. Barriers to the "observation option" physicians identified included: parental reluctance (83.5%) and cost and difficulty of follow-up among children who do not improve (30.9%).

Talking to the Parents about Otitis Media in Children

Explain to parents that most ear infections will improve on their own in two or three days, especially in children two years of age and older. Children can be given over-the-counter pain relievers for a few days. Taking antibiotics should be avoided whenever possible. Remind parents that if their child's symptoms do not improve in two to three days or worsen at any time, they should see the doctor. In addition, to prevent AOM, encourage:

  • Pneumococcal conjugate vaccine and annual influenza vaccine to all children according to updated schedules;
  • Exclusive breastfeeding for 6 months or longer; and
  • Avoidance of tobacco smoke exposure.

Providing Antibiotic Stewardship to Patients: General Talking Points

  • Provide Clear Recommendations
  • Elicit Patient Beliefs and Questions
  • Provide Empathy, Partnership Legitimation
  • Confirm Agreement/Overcome Barriers

AOM in Children: Resources

Online Resources

Choosing Wisely®

National medical specialty societies developed lists of evidence-based recommendations regarding appropriateness of tests and procedures that clinicians and patients should discuss. Additional information is available at:http://www.choosingwisely.org/. Choosing Wisely® is an initiative of the ABIM.

CDC Get Smart About Antibiotics Week

This is an annual one-week observance to raise awareness about antibiotic use, resistance, and appropriate prescribing practices.

The next Get Smart Week is November 12-18, 2017

 Visit the Get Smart website for more information.

Consumer Health Choices, In Depth: Antibiotics - Website provides educational resources and articles on the use and misuse of antibiotics from Consumer Reports and the CDC.

Less is More Medicine list of resources


Illinois Academy of Family Physicians
747 E. Boughton Road, Ste. 253

Bolingbrook, IL 60440