ENT problems in Dutch children: Trends in incidence rates, antibiotic prescribing and referrals 2002-2008

Background. Ear, nose, and throat (ENT) problems are common in childhood and are important reasons to visit the general practitioner. Objective. To examine trends in incidence rates, antibiotic prescribing, and referrals of five common ENT problems in children. Design. Netherlands Information Network of General Practice (LINH), a nationally representative general practice database. Setting. A total of 50 000 children, aged 0-17 years, registered in Dutch general practice over the period 2002-2008. Methods. Incidence rates were calculated and trends were analysed using linear regression analysis, with incidence rates per age group, proportion treated with antibiotics, and referrals as dependent variables and year of observation as independent variable. Results. In general, incidence rates of acute otitis media, serous otitis, sinusitis, tonsillitis, and tonsil hypertrophy remained stable over the period 2002-2008. An increasing trend was observed for serous otitis media in children aged 0-4 years (RR = 1.04, p < 0.001). A decreasing trend was observed for sinusitis in children aged 5-11 and for tonsillitis in children aged 11-17 years (RR 0.99, p < 0.001 and RR 0.94, p < 0.001, respectively). Antibiotics were prescribed in 10-60% of the diagnoses. An increasing trend for antibiotic prescription was found for acute otitis media (beta = 0.07, p < 0.001), mainly on account of amoxicillin. Although antibiotic treatment of tonsillitis remained stable, pheneticillin prescriptions showed a downward trend (beta = -0.10, p < 0.001). First-choice antibiotics were prescribed in > 80% of cases. Conclusions. This study showed remarkably stable trends in incidence rates, antibiotic prescribing, and referrals of common ENT problems. The low proportion of antibiotic treatment in ENT problems did not show negative consequences.