Abstract
Background
Acute otitis media (AOM) is a common pediatric infection, and spontaneous tympanic membrane perforation and otorrhea represent a clinically significant subset that requires specific management. Understanding current practices among pediatricians is crucial for identifying areas of concordance with guidelines, management strategies, and potential educational needs.
Methods
A national survey was conducted among Italian pediatricians, including both family pediatricians and hospital-based specialists, to assess their attitudes and practices regarding the definition, epidemiology, diagnosis, and treatment of AOM with otorrhea. A dedicated questionnaire included 20 items concerning different aspects of AOM management, including the potentiality of topical treatment for otorrhea. Data were also stratified for age, type of work, and geographic area.
Results
Five hundred pediatricians participated in the survey. The survey revealed that 57.6% of respondents preferred “acute otitis media with otorrhea” as the disease definition. AOM with otorrhea is most frequently observed in winter (45%) and autumn/spring (25% each). Approximately two-thirds of pediatricians (66%) manage 5–20 cases monthly during peak incidence. Otorrhea is reported in <10% of AOM cases by 58.6% of practitioners. A substantial majority (80.2%) initiate antibiotic treatment at the first observation in the presence of otorrhea, primarily systemic (78.2%), with amoxicillin-clavulanate (60.2%) being the preferred drug for 8–10 days (72.4%). Recurrences within 3 months are reported by 72.8% of respondents, with <10% of patients reporting them. There is raised interest in treatment alternatives (85.8%) and a preference for topical administration for specific patient categories (60.6%).
Conclusions
This national survey suggests that Italian pediatricians commonly favor early antibiotic treatment for acute otitis media with otorrhea, while areas of uncertainty remain regarding watchful waiting, treatment duration, and the role of topical therapy. These findings highlight the need for clearer, practice-oriented guidance and further research.
Keywords: Acute otitis media, Otorrhea: spontaneous tympanic membrane perforation, Antibiotic therapy, Topical therapy, Pediatric practice, Survey
Introduction
Acute otitis media (AOM) remains one of the most common infectious diseases in childhood and a leading cause of antibiotic prescription in pediatric practice globally [1]. Globally, AOM affects an estimated 709 million children annually, with 51% occurring in children under 5 years of age [2]. In Italy, AOM represents one of the most frequent diagnoses in pediatric primary care, accounting for a substantial proportion of antibiotic prescriptions in children under 6 years of age [3]. A particular clinical presentation, AOM accompanied by spontaneous tympanic membrane perforation and subsequent otorrhea, represents a more complex and potentially more severe subset of the disease. This condition is characterized by purulent discharge from the middle ear through a perforated tympanic membrane, indicating a breach of the natural barrier against external pathogens. The clinical significance of AOM with otorrhea stems from its potential for a prolonged course, increased risk of local and systemic complications, and its impact on the child’s quality of life, including pain, discomfort, and temporary hearing impairment [4]. Epidemiologically, AOM with otorrhea contributes significantly to the overall burden of ear infections in pediatric populations, with varying incidence rates influenced by age, seasonal factors, and socioeconomic status [2, 3].
The management of AOM with otorrhea presents several challenges, ranging from diagnostic accuracy to therapeutic decision-making. Despite the availability of national and international guidelines for AOM, specific recommendations for cases complicated by spontaneous perforation and otorrhea can sometimes lead to divergent practices among clinicians [1, 4–6]. Key dilemmas include the appropriate route and timing of antibiotic administration (systemic versus topical), the duration of treatment, management of recurrent episodes, and the role of watchful waiting versus immediate intervention. Recent studies have highlighted growing concerns about antibiotic resistance patterns and the imperative to optimize antibiotic use in pediatrics [7, 8]. Therefore, understanding pediatricians’ current practice patterns and perceptions is paramount to identify areas of alignment with evidence-based guidelines and potential gaps that may warrant further education or refined clinical protocols [9].
Based on this background, the Italian Society of Pediatric Allergy and Immunology (SIAIP), Italian Society of Pediatric Emergency and Urgency (SIMEUP), and Italian Federation of Pediatricians (FIMP) promoted a survey on AOM management in clinical practice.
This national survey aimed to comprehensively assess the current approaches of Italian pediatricians, encompassing both family pediatricians and hospital-based specialists, in the management of AOM with otorrhea. The primary objectives were to investigate their understanding of the disease definition, their observations on its epidemiology, their diagnostic strategies, and their therapeutic choices. Furthermore, the survey sought to explore their attitudes towards existing treatments, their experiences with disease recurrence, and their perspectives on future therapeutic alternatives. By elucidating these aspects, this study provides valuable insights into real-world clinical practices in Italy, highlighting strengths and identifying opportunities for improved care and adherence to best practices in the management of AOM with otorrhea.
Methods
A cross-sectional national survey was conducted among Italian pediatricians to assess current clinical practices in the management of acute otitis media with spontaneous tympanic membrane perforation and otorrhea. The survey targeted both family pediatricians practicing in primary care settings and hospital-based pediatric specialists across Italy to capture a comprehensive view of current clinical practices in different healthcare contexts. Participants were categorized as family pediatricians (primary care) and hospital-based pediatric specialists, including those working in university-affiliated tertiary hospitals. Emergency department pediatricians were grouped with hospital-based specialists.
The survey was conducted from September 29th to November 7th 2025. Seasonal categories were defined in the questionnaire as winter (December–February), spring (March–May), summer (June–August), and autumn (September–November), considering the weather calendar.
The questionnaire was developed based on current Italian guidelines published by the Italian Society of Pediatrics in 2019 [1], a subsequent Italian intersociety Consensus in 2025 [4], international evidence on AOM with otorrhea management, and input from a multidisciplinary expert panel comprising pediatricians with expertise in managing infectious diseases of the upper airways and an immunologist.
The survey explored six main domains with 20 questions (Table 1): disease definition and nomenclature; epidemiological observations; diagnostic approaches; therapeutic strategies; recurrence management; and future perspectives. The survey employed a convenience sampling strategy, targeting Italian pediatricians who were registered members of SIAIP, SIMEUP, and/or FIMP and who were invited to participate via the official professional society networks (newsletter and email distribution). The total number of pediatricians reached through these networks and the corresponding response rate could not be determined, as the exact number of recipients of the survey invitation was not available. This represents a methodological limitation that should be considered when interpreting the generalizability of the findings. Globally, 500 complete responses were received. Data collection was conducted via an online survey platform distributed via email to registered pediatricians via the above-mentioned professional society networks. This survey was reported in accordance with the CHERRIES (Checklist for Reporting Results of Internet-E-Surveys) guidelines [10].
Table 1.
Results of the survey
| Question/Answer | % (n = 500) | n |
|---|---|---|
| Demographics | ||
| Age (Years) | ||
| a. <40 | 19% | 95 |
| b. 40–60 | 37% | 185 |
| c. >60 | 44% | 220 |
| Specialistic area | ||
| a. Primary care | 79% | 395 |
| b. Hospital | 21% | 105 |
| Definition and Epidemiology of the Disease | ||
| Question 1. Which term for this condition do you think is most correct? | ||
| a. Acute otitis media complicated by spontaneous perforation of the tympanic membrane | 58% | 290 |
| b. Acute otitis media with otorrhea | 42% | 210 |
| Question 2. In which seasons do you most frequently see patients with acute otitis media (multiple answers possible)? | ||
| a. Fall-winter | 29% | 145 |
| b. Winter | 22% | 110 |
| c. Winter-spring | 9% | 45 |
| d. There are no significant differences | 13% | 65 |
| e. Other answers | 27% | 135 |
| Question 3. How many patients with acute otitis media do you see each month during the months with the highest incidence? | ||
| a. <5 | 24% | 120 |
| b. 5 to 20 | 66% | 330 |
| c. >20 | 10% | 50 |
| Question 4. How often do you find otorrhea in your patients with acute otitis media? | ||
| a. <10% | 59% | 295 |
| b. 10–20% | 35% | 175 |
| c. 21–40% | 6% | 30 |
| Question 5. In your experience, in patients with acute otitis media, the presence of otorrhea: | ||
| a. Does not alter the course of the disease | 21% | 105 |
| b. Represents a complication that alters the course of the disease | 17% | 85 |
| c. Represents a complication that alters the course of the disease and requires a different therapeutic approach | 62% | 310 |
| Question 6. In which age group is otorrhea most common? | ||
| a. 0–6 months | 1% | 5 |
| b. 6–24 months | 48% | 240 |
| c. Over 2 years | 51% | 255 |
| Question 7. Does otoscopic examination allow you to identify perforation and signs of inflammation in the tympanic membrane? | ||
| a. No | 12% | 60 |
| b. Yes, but only in some cases | 72% | 360 |
| c. Yes, always | 16% | 80 |
| Question 8. Do you always schedule a follow-up visit with otoscopic examination after an episode of acute otitis media? | ||
| a. No | 12% | 60 |
| b. Yes, but only in some cases | 37% | 185 |
| c. Yes, always | 34% | 170 |
| d. Only after otitis media with otorrhea | 17% | 85 |
| Question 9. At the time of your initial observation, what percentage of patients had already begun treatment by their parents or another healthcare professional? | ||
| a. <10% | 66% | 330 |
| b. 10–20% | 20% | 100 |
| c. 21–40% | 10% | 50 |
| d. >40% | 4% | 20 |
| Current Treatment | ||
| Question 10. In the presence of otorrhea, what therapeutic approach do you usually take? | ||
| a. Initial period of watchful waiting and antibiotic treatment only subsequently, if necessary | 20% | 100 |
| b. Antibiotic treatment upon first observation | 80% | 400 |
| Question 11. In the case of antibiotic treatment, what method of administration do you usually adopt? | ||
| a. Systemic | 78% | 390 |
| b. Topical | 2% | 10 |
| c. Systemic and topical | 20% | 100 |
| Question 12. In the absence of allergies, which antibiotic treatment do you use most frequently? | ||
| a. Amoxicillin | 38% | 190 |
| b. Amoxicillin-clavulanate | 60% | 300 |
| c. Cephalosporins | 2% | 10 |
| Question 13. What duration of antibiotic treatment do you usually adopt in cases of acute otitis media with otorrhea? | ||
| a. 5–7 days | 26% | 130 |
| b. 8–10 days | 72% | 360 |
| c. >10 days | 2% | 10 |
| Question 14. In what percentage of patients with acute otitis media with otorrhea do you observe recurrences in the following 3 months? | ||
| a. <10% | 73% | 365 |
| b. 10–50% | 26% | 130 |
| c. >50% | 1% | 5 |
| Question 15. In the event of a recurrence of acute otitis media with otorrhea within 3 months, which antibiotic treatment do you most frequently use? | ||
| a. The same as for the first episode | 34% | 170 |
| b. Different from the first episode | 47% | 235 |
| c. I decide based on the results of a bacteriological examination of the otorrhea | 19% | 95 |
| Question 16. In the event of a recurrence of acute otitis media with otorrhea within 3 months, what duration of antibiotic treatment do you most frequently adopt? | ||
| a. The same as for the first episode | 68% (9 days) | 340 |
| b. Longer than for the first episode | 32% (11 days) | 160 |
| Future Prospectives | ||
| Question 17. Do you think it would be useful to have alternatives to antibiotic treatment in the future? | ||
| a. No | 14% | 70 |
| b. Yes, in relation to issues of both efficacy and tolerability | 86% | 430 |
| Question 18. For antibiotic treatment, could topical administration be a useful alternative to systemic administration? | ||
| a. No | 31% | 155 |
| b. Yes, for all patients | 8% | 40 |
| c. Yes, but only for certain types of patients | 61% | 305 |
| Question 19. If your answer to the previous question was c., in which categories of patients would you prescribe topical therapy rather than systemic therapy? (multiple choice; n = 305) | ||
| a. Missing | 36%* | 110* |
| b. In children over 2 years of age and in stable general condition | 16%* | 49* |
| c. In children over 2 years of age, in stable general condition, and with a first episode of AOM with otorrhea | 9%* | 27* |
| d. In children in stable general condition | 8%* | 24* |
| e. In children over 2 years of age, in stable general condition, and even with recurrent AOM with otorrhea | 6%* | 18* |
| f. Other responses | 25%* | 76* |
| Question 20. For topical treatment, would you consider it useful to have: | ||
| a. A solution containing only antibiotics | 28% | 140 |
| b. A solution containing a combination of antibiotics and corticosteroids | 30% | 150 |
| c. Both | 42% | 210 |
N = 500 total respondents. *For question 19, percentages and absolute values are calculated on n = 305 (respondents who answered ‘Yes, but only for certain types of patients’ to question 18)
Statistical analyses were performed using SAS® release 9.4 (64-bit) or later (SAS Institute, Inc., Cary, NC, USA). Data were pooled and summarized using descriptive statistics. Continuous data were summarized with n, mean, standard deviation (SD), median, first and third quartiles (Q1, Q3), and range (minimum and maximum values). Categorical data were presented as absolute and relative frequencies (n and %) or contingency tables. Percentages were calculated based on total values, with counts shown also in the missing category unless otherwise specified.
Ethical considerations
This study was conducted in accordance with the principles of the Declaration of Helsinki. The survey was promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP), and formal ethical approval was determined to be not required, as the survey was administered exclusively to healthcare professionals and did not involve the collection of patient-level data, personally identifiable information, or any sensitive clinical data. In accordance with applicable Italian and European regulations (GDPR), no formal ethics committee exemption certificate was required for this type of anonymous, voluntary survey of healthcare professionals. Participation was entirely voluntary and anonymous. Email addresses used for survey distribution were obtained through official professional society networks, whose members had consented to receive professional communications. No personal data were stored or processed beyond the purposes of this study.
Results
Table 1 summarizes the responses expressed as percentages of respondents and Figure 1 reports the results concerning some relevant questions. The survey achieved participation from Italian pediatricians practicing across Italy’s regions. Given the convenience sampling strategy and the unavailability of the total number of invited participants, the sample cannot be considered strictly representative of the entire Italian pediatric workforce. Five hundred pediatricians participated in the survey (response rate: not determinable, as the total number of invited participants was not available). Most participants (44%) were > 60 years old. Respondents included both family pediatricians working in primary care settings (79%) and hospital-based specialists (21%), providing a comprehensive view of current clinical practices in the management of AOM with otorrhea. Of the 500 respondents, university-affiliated tertiary hospital specialists and emergency department pediatricians were 105 (21%). Respondents were distributed across all Italian regions.
Fig. 1.
Results concerning the question 10, 11, 13, and 17 distributed as percentages
Disease Definition and Nomenclature: The survey revealed that 58% (n = 290) of respondents preferred the term “acute otitis media complicated by spontaneous perforation of the tympanic membrane.” Variations in nomenclature persist, reflecting the lack of a universally standardized vocabulary.
Epidemiological Observations: Fall-winter emerged as the peak season, with 29% (n = 145) of pediatricians reporting the highest incidence. Winter and winter-spring accounted for 22% (n = 110) and 9% (n = 45), respectively. Approximately two-thirds of pediatricians (66%; n = 330) reported managing 5–20 AOM cases per month. 59% (n = 295) reported otorrhea in less than 10% of AOM cases. Most respondents (62%; n = 310) believe AOM with otorrhea represents a complication requiring a different therapeutic approach. Otoscopic examination is considered useful but only in some cases by 72% (n = 360) of participants. Less than 10% of patients were already treated before observation for 66% (n = 330) of participants.
Current Therapeutic Practices: 80% (n = 400) of pediatricians reported initiating antibiotic treatment at first observation, with only 20% (n = 100) preferring watchful waiting. 78% (n = 390) preferred systemic oral antibiotics. 60% (n = 300) preferred amoxicillin-clavulanate as first-line treatment. 72% (n = 360) routinely prescribe 8 to 10 days of antibiotic therapy. Regarding the route of antibiotic administration, 78% (n = 390) of respondents preferred systemic oral antibiotics as their primary treatment approach. This finding indicates limited current use of topical antibiotic preparations in clinical practice for AOM with spontaneous perforation, despite growing interest in topical therapies as potential antibiotic stewardship strategies. The limited use may depend on the absence of authorized drugs with a specific indication. Treatment duration practices revealed that 72% (n = 360) of pediatricians routinely prescribe 8 to 10 days of antibiotic therapy for AOM with otorrhea, regardless of patient age or disease severity characteristics. This finding suggests a relatively standardized approach to treatment duration that may not fully incorporate risk stratification based on patient-specific factors such as age, disease severity, or presence of complications.
Recurrence Patterns: 73% (n = 365) of pediatricians observe recurrences within 3 months in less than 10% of their patients.
Future Treatment Perspectives: 86% (n = 430) expressed strong interest in treatment alternatives. 61% (n = 305) indicated a preference for topical antibiotic administration in specific patient categories. This interest may also depend on the absence of authorized drugs with this specific indication. This high level of interest indicates openness to evidence-based innovations and suggests receptivity to new therapeutic strategies that might offer improved outcomes or reduced adverse effects. Additionally, 61% (n = 305) of pediatricians indicated a preference for topical antibiotic administration in specific patient categories. Most participants consider topical products containing antibiotics useful.
Sub-analysis: The stratifications by age of participants, work setting (primary care or hospital), and geographic area were performed descriptively and did not reveal apparent differences in the main practice patterns reported.
Discussion
To our knowledge, this is the first national survey specifically addressing the management of AOM with spontaneous tympanic membrane perforation and otorrhea among Italian pediatricians, providing a comprehensive snapshot of real-world clinical practices across different healthcare settings and geographic areas.
Because these findings are based on self-reported survey responses, they should be interpreted with appropriate caution. The survey provides valuable insights into current clinical practices among Italian pediatricians in the management of acute otitis media with spontaneous tympanic membrane perforation and otorrhea, and may suggest both areas of concordance with current evidence-based guidelines and important gaps that warrant attention through educational initiatives and guideline implementation strategies.
The survey finding that 80.2% of pediatricians initiate antibiotics immediately for AOM with otorrhea aligns well with recommendations from the Italian Society of Pediatrics guidelines published in 2019 [1], which consider AOM with otorrhea as a severe presentation requiring prompt treatment. This high rate of immediate antibiotic initiation may suggest appropriate recognition of the clinical significance of tympanic membrane perforation and is consistent with evidence showing that children with otorrhea benefit more from antibiotic treatment than those without perforation [9, 10].
The preference for amoxicillin-clavulanate as first-line treatment, reported by 60.2% of respondents, is consistent with SIP 2019 guidelines [1] recommending this combination for children with otorrhea due to the higher prevalence of beta-lactamase-producing bacteria in this clinical presentation. This practice is further supported by recent epidemiological data from a large French prospective study of 852 children with spontaneous perforation [3, 4], which identified non-typeable Haemophilus influenzae as the most common pathogen in children under 3 years of age, accounting for 49.7% of cases, particularly in those with complex AOM where it represented 57.1% of isolates. Group A Streptococcus was predominant in children over 3 years of age, accounting for 57% of cases, while Streptococcus pneumoniae ranked third overall at 25.1%, with serotype 3 being the most common at 16.2%, followed by serotype 23B at 15.2%. These epidemiological findings may help justify the preference for broad-spectrum coverage in AOM with otorrhea, although they also highlight the need for continued surveillance of bacterial etiology and resistance patterns in the Italian pediatric population.
However, several important gaps between current practice and evidence-based recommendations were identified. The limited adoption of watchful waiting strategies, with only 19.8% of pediatricians considering an observation period before initiating antibiotics, may represent an area for improvement relative to current guidelines. The Italian Intersociety Consensus 2025 [2] recommends watchful waiting for children over 6 months without severe symptoms, with appropriate follow-up within 48 to 72 hours. This approach has been shown to reduce antibiotic use without compromising outcomes in selected cases [8, 9]. The low adoption of watchful waiting in Italian practice may reflect several factors, including parental expectations for immediate treatment, concerns about complications, and practical difficulties in ensuring adequate follow-up in busy primary care settings. Educational interventions addressing these barriers and providing practical strategies for implementing watchful waiting, such as clear communication protocols with parents, reliable follow-up systems, and delayed antibiotic prescriptions, may help bridge this gap.
The finding that 72.4% of pediatricians routinely prescribe 8 to 10 days of antibiotic therapy regardless of patient characteristics may suggest an area for further optimization. Current guidelines, including the Italian Intersociety Consensus 2025 [2], recommend individualizing treatment duration based on patient age and disease severity, with 5 to 7 days being adequate for uncomplicated cases in children over 2 years of age, while 7 to 10 days is recommended for children under 2 years, those with bilateral AOM, recurrent episodes, or severe symptoms [11–13]. This risk-stratified approach to treatment duration has the potential to reduce unnecessary antibiotic exposure while ensuring adequate treatment for high-risk groups.
The strong interest in topical antibiotic therapy, expressed by 60.6% of respondents, requires careful consideration in light of recent evidence. A Dutch randomized controlled non-inferiority trial published in 2024 [5] compared hydrocortisone-bacitracin-colistin eardrops with oral amoxicillin in 58 children with AOM and ear discharge. Although the trial was terminated early due to slow accrual, the available data suggested that oral antibiotics may be more effective than antibiotic-corticosteroid eardrops in resolving symptoms and shortening the duration of ear discharge. Children assigned to eardrops had lower resolution rates of ear pain and fever at 3 days compared to those receiving oral antibiotics (42% versus 65%), longer parent-reported ear discharge duration (6 versus 3 days), and slightly higher mean ear pain scores over days 1 to 3. However, children receiving eardrops had fewer total oral antibiotic courses in 3 months and experienced less gastrointestinal upset and rash. These findings support oral antibiotics as more effective than topical treatment for spontaneous perforation, while topical antibiotics remain proven for ventilation tube-related otorrhea. Accordingly, the Italian Intersociety Consensus 2025 [2] recommends against topical antibiotic therapy for spontaneous perforation.
Although this survey documents important practice patterns, it does not identify the factors driving those patterns. Variables such as years of experience, practice setting, access to follow-up, and patient demographics may influence decision-making, but these were not captured in sufficient detail here. Future research should explore these determinants more directly, as understanding them may help tailor implementation strategies and educational interventions.
The purely descriptive nature of this study limits its ability to identify causal relationships or explain the observed practice patterns. At minimum, future analyses could explore whether available variables such as age group and workplace setting are associated with specific prescribing behaviors, even within the constraints of a descriptive design.
Several limitations of this study should be acknowledged. First, as a survey-based study, findings rely on self-reported practices, which may not accurately reflect actual clinical behavior due to social desirability bias or recall bias. Second, the absence of patient-level data precludes any assessment of clinical outcomes associated with the reported practices. Third, the response rate and the sampling strategy may introduce selection bias, potentially overrepresenting pediatricians with a particular interest in AOM management. Fourth, seasonal categories were not formally defined in the questionnaire, which may limit the comparability of seasonal data across respondents. Fifth, the lack of detailed demographic data (e.g., years of experience, gender, urban vs. rural setting) limits the ability to identify factors associated with specific practice patterns. Sixth, the analysis was exclusively descriptive; no inferential statistics were performed, as the study was designed and conducted as a descriptive survey. Post hoc inferential analyses were not pre-specified and would risk introducing multiple comparisons bias. Seventh, the questionnaire was not formally pilot-tested prior to distribution. This methodological limitation may have affected the clarity, comprehensiveness, and internal consistency of some survey items. Without pilot testing, it is not possible to assess whether all questions were interpreted uniformly by respondents, which may introduce measurement error and limit the comparability of responses across participants. Future surveys on this topic should incorporate formal pilot testing with a representative subsample of the target population. Furthermore, the representativeness of the sample warrants careful consideration. While 500 respondents from across Italian regions were included, the convenience sampling strategy means that the sample likely overrepresents pediatricians who are members of professional societies and who have a particular interest in AOM management. Pediatricians practicing in rural or underserved areas, those not affiliated with professional societies, and those with less interest in the topic may be underrepresented. These potential biases should be considered when generalizing the findings to the broader Italian pediatric community. These limitations should be considered when interpreting the findings and generalizing the results to the broader Italian pediatric community.
Conclusive remarks
This national survey suggests broad consensus among Italian pediatricians on early antibiotic initiation for AOM with otorrhea, with approximately 80% starting treatment at first observation. The preference for amoxicillin-clavulanate as first-line therapy, reported by about 60% of respondents, appears consistent with current guidelines.
At the same time, the limited adoption of watchful waiting (20%) and the routine use of 8–10-day courses regardless of patient characteristics may indicate opportunities for risk-stratified prescribing and targeted educational initiatives.
Interest in topical antibiotic therapy (61%) should be interpreted cautiously in light of recent evidence favoring oral antibiotics for spontaneous perforation. Future research should investigate the determinants of prescribing behavior and the effectiveness of implementation strategies in primary care settings.
Acknowledgements
We would thank the CRO OPIS (Desio, MI, Italy) which supported the initiative. The support provided by OPIS consisted of logistical assistance with web platform preparation, data collection and descriptive analysis. No financial compensation was provided to survey participants.
Abbreviation
- AOM
Acute otitis media
Author contributions
GLM, PM, and GC conceptualized and designed the study; AD’A, SZ, and MMdG collected and interpreted data; GC conducted the initial analyses, drafted and revised the manuscript; GLM, AD’A, SZ, MMdG and PM revised and edited the manuscript. All authors approved the final manuscript and agreed to be accountable for all aspects of the work.
Funding
This work was supported by SIAIP, FIMP, and SIMEUP.
Declarations
Ethical approval
Formal ethical approval was not required for this study, as it involved a voluntary, anonymous survey administered exclusively to healthcare professionals and did not involve the collection of patient-level data or personally identifiable information. The study was conducted in accordance with the principles of the Declaration of Helsinki. Email addresses used for survey distribution were obtained through official professional societies and networks, whose members had consented to receive professional communications.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Marchisio P, Galli L, Bortone B, Ciarcià M, Motisi MA, Novelli A, et al. Updated guidelines for the management of acute otitis media in children by the Italian Society of Pediatrics: treatment. Pediatr Infect Disease J. 2019;38(12S):S10–21. 10.1097/INF.0000000000002452. [DOI] [PubMed]
- 2.Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One. 2012;7(4):e36226. 10.1371/journal.pone.0036226. [DOI] [PMC free article] [PubMed]
- 3.Marchisio P, Cantarutti L, Sturkenboom M, Girotto S, Picelli G, Dona D, et al. Burden of acute otitis media in primary care pediatrics in Italy: a secondary data analysis from the pedianet database. BMC Pediatr. 2012;12(1):185. 10.1186/1471-2431-12-185. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Castelli Gattinara G, Bergamini M, Simeone G, Reggiani L, Doria M, Ghiglioni DG, et al. Antibiotic treatment of acute and recurrent otitis media in children: an Italian intersociety Consensus. Ital J Pediatr. 2025;51(1):50. 10.1186/s13052-025-01894-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.National Institute for Health and Care Excellence. Otitis media (acute): antimicrobial prescribing. NICE guideline NG91. Published 2018, updated 2022. Available at: https://www.nice.org.uk/guidance/ng91.
- 6.Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964–99. 10.1542/peds.2012-3488. [DOI] [PubMed]
- 7.Levy C, Varon E, Ouldali N, Wollner A, Thollot F, Corrard F, et al. Bacterial causes of otitis media with spontaneous perforation of the tympanic membrane in the era of 13 valent pneumococcal conjugate vaccine. PLoS One. 2019;14(2):e0211712. 10.1371/journal.pone.0211712. [DOI] [PMC free article] [PubMed]
- 8.Levy C, Varon E, Bidet P, Bechet S, Batard C, Wollner A, et al. Otorrhea bacterial profile, epidemiology before widespread use of the third-generation pneumococcal conjugate vaccine in French children, a prospective study from 2015 to 2023. Infect Dis Now. 2023;53(6):104738. 10.1016/j.idnow.2023.104738. [DOI] [PubMed] [Google Scholar]
- 9.Hullegie S, Damoiseaux RAMJ, Hay AD, Zuithoff NPA, van Dongen TMA, Little P, et al. Topical or oral antibiotics in childhood acute otitis media and ear discharge: a randomized controlled non-inferiority trial. Fam Pract. 2024;41(5):857–61. 10.1093/fampra/cmae034. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Eysenbach G. Improving the quality of web surveys: the Checklist for reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34. 10.2196/jmir.6.3.e34. [DOI] [PMC free article] [PubMed]
- 11.Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Systematic Rev. 2015;2015): CD000219.6). 10.1002/14651858.CD000219.pub4. [DOI] [PMC free article] [PubMed]
- 12.Rovers MM, Glasziou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet. 2006;368(9545):1429–35. 10.1016/S0140-6736(06)69606-2. [DOI] [PubMed] [Google Scholar]
- 13.Tähtinen PA, Laine MK, Huovinen P, Jalava J, Ruuskanen O, Ruohola A. A placebo-controlled trial of antimicrobial treatment for acute otitis media. N Engl J Med. 2011;364(2):116–26. 10.1056/NEJMoa1007174. [DOI] [PubMed] [Google Scholar]