Background
Acute otitis media is a common community-acquired infection and the majority of children will experience at least one episode of it during childhood. Children recover spontaneously without treatment, and antibiotics only have a modest overall benefit on the clinical course of acute otitis media. Twenty children have to be treated with antibiotics to prevent one child suffering ear pain after 2–7 days – that is, a number needed to treat to benefit of 20. The benefits of antibiotics are in the same order as the mild adverse effects, such as diarrhoea and candidiasis, which have numbers needed to harm of 14. Antibiotics seem to be most beneficial in children younger than 2 years of age with bilateral acute otitis media, and in children with both acute otitis media and otorrhoea.
Decisions about whether to use antibiotics need to weigh up their benefits with their harms, as prescribing leads to antibiotic resistance. Antibiotic resistance is an increasing public health concern, not only at a population level, but also for individual patients, for whom use of antibiotics can result in bacterial resistance to that antibiotic for up to 12 months. Although, current guidelines recommend withholding antibiotics in most cases of children with acute otitis media, many are still treated with antibiotics. Antibiotic prescribing rates vary considerably between countries from less than 50 % in Dutch primary care to more than 80 % in primary care in the UK. One of the likely drivers of antibiotic overuse is demand, perceived or real, from parents. It is well-known that patients (or parents') expectations of antibiotics influence general practitioners' (GPs) decision to prescribe them. Patients who are perceived by clinicians as expecting an antibiotic are 10 times more likely to be prescribed one. However, there has been little exploration into parents' expectations of the management of acute otitis media in children and what influences the development of these expectations. GPs need to be aware of parents' knowledge and expectations to facilitate optimal communication during the consultation. The aim of this study was to explore parents' knowledge and beliefs about the management of acute otitis media in children.