Overuse of antibiotics is an ongoing concern because of antibiotic resistance. We previously found that half of the antibiotic suspensions prescribed to children in our practice were given for acute otitis media. We were not convinced that all of these children needed antibiotics in view of a systematic review of the evidence,1 and in July 1997, we decided to see if we could change our practice.

SETTING AND DESIGN

Manor View and Attenborough practices serve the population in Bushey and Oxhey, a suburban setting in south west Hertfordshire. They are both training practices, with similar list sizes of about 11 000 patients and relatively few patients who do not have English as their first language.

We adopted an evidence-based patient handout for parents and also started to offer a deferred antibiotic prescription (with advice not to give the antibiotics immediately) for children with earache and inflamed eardrums who were not unduly ill. In March 1999, we published the results of a before–after study in which we compared prescribing of amoxicillin suspensions in our practice (Manor View) with that of a nearby control practice (Attenborough) over the first year after we changed practice.2 We now report what happened to prescribing in the subsequent 3 years.

MEASURES OF IMPROVEMENT

Reduction in antibiotic load on children is important to their parents, and therefore, this was the key outcome measure. PACT (Prescribing Analysis and Cost) data …