Why do nurse practitioners in primary care prescribe antibiotics for children with otitis media and what influences them to prescribe outside guideline recommendations? These were some of the issues explored in this interview-based study with eight nurse practitioners who were independent prescribers. Previous studies have suggested that nurse practitioners and physicians prescribe in a similar manner, but there has been little work on identifying and analysing the factors that lead them to prescribe antibiotics or how they think through their prescribing practice.
The evidence is that most cases of otitis media are viral and self-limiting and do not require antibiotics, with the option for a delayed prescription when the antibiotic indications are borderline or the parent needs reassurance. Most of the nurse practitioners described occasions when they would reject the guideline recommendations, and external influences were sometimes at play here (such as time of day, lack of family knowledge, location). The authors conclude that efforts to reduce antibiotic prescribing will need interventions that are workable in practice and focus on those situations where nursers override policy and research evidence.
Philp A and Winfield L. Why prescribe antibiotics for otitis media in children? Nurse Prescribing 2010; 8(1): 14-19.