“Watchful waiting” approach works – but better communication from healthcare providers is needed
US researchers have explored how to reduced unwarranted antibiotic use for acute otitis media in children, specifically looking at the influence of healthcare practitioners’ instructions and parent compliance.
They found only 4% of parents who were advised to delay antibiotics use for their children’s ear infections actually recalled receiving advice, including information about the infection, risks of antibiotics, and how to properly care for their children.
The study of 135 parents of children under five years old also showed that even when parents reported receiving explanations about the risks of antibiotics, their understanding of what they heard was not necessarily complete or correct.
Parents who recalled receiving more detailed explanation from their healthcare providers were more likely to use antibiotics only if they were truly needed.
“Only 4% of parents who were advised to delay antibiotics use for their children’s ear infections actually recalled receiving advice”
The study’s lead author, Associate Professor Erina MacGeorge from Pennsylvania State University, explains that “watchful waiting” is an effective way to reduce unnecessary antibiotic use, without affecting patient safety.
“When we use antibiotics, the strongest bacteria still survive even though we feel well again,” says A/Prof Erina MacGeorge.
“Over time, these bacteria adapt to become resistant ‘superbugs’ that even very strong antibiotics with dangerous side effects cannot kill.
“Our best defence is to avoid antibiotics whenever possible, with guidance from health professionals.”
The findings of the study suggest parents’ compliance with watchful waiting advice could be increased by enhancing instructions from healthcare practitioners.
According to US paediatric guidelines, parents advised to undertake watchful waiting should receive information on:
- The nature of ear infections;
- Adverse effects of antibiotics;
- How to monitor and manage symptoms such as pain; and
- When to seek follow-up care.
NPS MedicineWise states that clinicians should discuss ‘wait and see’ prescribing with parents who prefer antibiotic treatment.
“Provision of a script for an antibiotic along with advice only to use it if the pain persists for 48 hours will reduce antibiotic use by two-thirds (with no negative impact on family satisfaction),” says NPS MedicineWise.
An Australian Family Physician study found that Australian GPs prefer to prescribe antibiotics for children with otitis media, and parental pressure plays a part.
“The provision of antibiotics for OM may be patient/parent driven and for a variety of reasons – children in pain, parental expectation and belief that pain management alone is insufficient. Information and education about the implications of antibiotic use can alter some of these behaviours and expectations.”
The US researchers agree, stating that “healthcare providers should communicate strategically to improve parents’ comprehension and recall.
“Healthcare providers can utilise ‘teach-back’ techniques, asking parents to paraphrase what they should do to monitor and manage symptoms,” say the authors.