Objectives
It is not known if the primary care management of acute otitis media (AOM) in Canada is congruent with published guidelines. We compared the current treatment practices for paediatric AOM at a Toronto primary care clinic with 2009 Canadian Paediatric Society (CPS) AOM guidelines.

Methods
This retrospective chart review of electronic medical records (EMR) was conducted at an academic family health team in Toronto. Data were collected from patients identified using billing code reports and an EMR keyword search. Patients aged 6 months to 12 years and diagnosed with AOM between January 1 2013 and December 31 2015 were eligible for inclusion. Severe and/or complex AOM cases were excluded. The primary and secondary outcomes were the respective congruence of the treatment approach and the prescribed antibiotic regimen with 2009 CPS AOM guidelines. For the primary outcome, the choice to treat with watchful waiting or immediate antibiotic therapy was reviewed and compared to guideline recommendations. For the secondary outcome, we compared all prescribed antibiotic regimens to guidelines according to choice of drug, dose, and duration of therapy.

Results
A total of 138 cases met our inclusion criteria. The decision of whether or not to prescribe antibiotics was congruent with guidelines in 81% of cases (n = 112/138). However, watchful waiting was warranted in 40% of the cases prescribed immediate antibiotic therapy (n = 17/43). When antibiotics were prescribed (n = 91), the choice of drug, weight-based dose, and duration of therapy were all guideline-congruent in 38% of cases. The remaining prescriptions deviated from Canadian guideline recommendations in one or more domains, most frequently for dose and duration of therapy.

Conclusion
Current treatment practices for paediatric AOM in our clinic were largely congruent with 2009 Canadian Paediatric Society treatment guidelines, with opportunities to maximize watchful waiting and optimize dosing and duration of antibiotic therapy.