Antibiotic Prescribing Patterns for Acute Otitis Media for Children 2 Years and Older
Holly M Frost1, Lauren F Becker2, Bryan C Knepper3
1Department of Pediatrics, Denver Health Medical Center, Denver, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Insights
Most children with acute otitis media received antibiotics longer than recommended, with nearly half getting 10 or more days. Interventions should focus on antibiotic duration, not just first-line choices, to improve prescribing for pediatric acute otitis media.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Health services research
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Antibiotic prescribing for AOM often deviates from guidelines.
- Optimizing antibiotic use is crucial for combating antimicrobial resistance.
Purpose of the Study:
- To determine the frequency of non-first-line antibiotics, safety-net antibiotic prescriptions (SNAPS), and extended antibiotic durations for children with AOM.
- To identify patient and system-level factors influencing these prescribing patterns.
Main Methods:
- Retrospective chart review of 1025 children (≥2 years) with AOM at Denver Health outpatient sites (2018).
- Analysis of antibiotic choice, duration, and use of SNAPS.
- Multivariate logistic regression to identify factors associated with non-first-line and prolonged antibiotic therapy.
Main Results:
- 98.0% of AOM visits received an antibiotic prescription.
- 18.8% received non-first-line antibiotics; 4.5% received SNAPS.
- 94.1% of antibiotic courses exceeded the recommended 5-day duration, with 54.3% lasting ≥10 days.
- Private insurance, younger age (2-5 years), and emergency/urgent care site visits were associated with longer antibiotic durations.
Conclusions:
- Antibiotic stewardship efforts for AOM should prioritize antibiotic duration and consider SNAPS or observation.
- System and patient factors significantly influence deviations from guideline-recommended antibiotic prescribing for AOM.
Objective:
To determine the frequency that non-first-line antibiotics, safety-net antibiotic prescriptions (SNAPS), and longer than recommended durations of antibiotics were prescribed for children ≥2 years of age with acute otitis media and examine patient and system level factors that contributed to these outcomes.
Study Design:
Children age ≥2 years with acute otitis media seen at Denver Health Medical Center outpatient locations from January to December 2018 were included. The percentages of patients who received first-line antibiotics, SNAPs, and recommended durations of antibiotics were determined. Factors associated with non-first-line and longer than recommended antibiotic durations were evaluated using multivariate logistic regression modeling.
Results:
Of the 1025 visits evaluated, 98.0% were prescribed an antibiotic; only 4.5% of antibiotics were SNAPs. Non-first-line antibiotics were prescribed to 18.8% of patients. Most antibiotic durations (94.1%) were longer than the institution recommended 5 days and 54.3% were ≥10 days. Private insurance was associated with non-first-line antibiotics (aOR, 1.89; 95% CI, 1; 14-3.14, P = .01). Patients who were younger (2-5 years; aOR 2.01; 95% CI, 1.32-3.05; P < .001) or seen in emergency/urgent care sites (aOR, 1.73; 95% CI, 1.26-2.38; P < .001) were more likely to receive ≥10 days of antibiotic compared with those in pediatric clinics.
Conclusions:
Antibiotic stewardship interventions that emphasize the duration of antibiotic therapy as well as the use of SNAPs or observation may be higher yield than those focusing on first-line therapy alone. Numerous system and patient level factors are associated with off-guideline prescribing.
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