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Outpatient Antibiotic Prescribing for 357,390 Children With Otitis Media
Péter Csonka1,2, Sauli Palmu1, Paula Heikkilä1
1From the Department of Pediatrics, Tampere University Hospital, Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research.
Insights
Antibiotic prescribing for childhood otitis media (OM) decreased from 2014-2020. Amoxicillin and amoxicillin-clavulanic acid were increasingly used, while macrolides decreased, aligning with guidelines for pediatric OM treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic resistance is a growing global concern.
- Appropriate antibiotic selection for common childhood infections like otitis media (OM) is crucial.
- National guidelines recommend amoxicillin and amoxicillin-clavulanic acid as first-line treatments for OM.
Purpose of the Study:
- To evaluate antibiotic prescribing patterns for children diagnosed with otitis media (OM).
- To assess the adherence to national guidelines for first-line antibiotic therapy in pediatric OM.
- To analyze trends in the use of specific antibiotics, including amoxicillin, amoxicillin-clavulanic acid, and macrolides, between 2014 and 2020.
Main Methods:
- Retrospective analysis of electronic health records from a nationwide network of private clinics.
- Inclusion of approximately 250,000 annual visits for children under 18 years old.
- Focus on children diagnosed with OM and upper respiratory tract infections, excluding lower respiratory tract infections.
Main Results:
- Antibiotics were prescribed in 44.8% of 357,390 pediatric OM cases, with a decreasing trend from 48.3% in 2014 to 41.4% in 2020.
- Prescription rates for amoxicillin and amoxicillin-clavulanic acid remained relatively stable, while macrolide prescriptions significantly decreased from 7.5% to 3.5%.
- Adherence to guideline-recommended antibiotics varied by physician specialty, with pediatricians showing the highest rate (80.1%).
Conclusions:
- Antibiotic prescribing for pediatric otitis media shows a declining trend, with a notable reduction in macrolide use.
- While overall adherence to recommended antibiotics is improving, variations exist among different physician specialties.
- Continued monitoring and targeted interventions may further optimize antibiotic selection for otitis media in children.
Aim:
This study aimed to evaluate antibiotic prescriptions for children with otitis media (OM) in a large nationwide network of private clinics between 2014 and 2020. Special focus was paid to amoxicillin and amoxicillin-clavulanic acid prescriptions, which the national guidelines recommend for first-line drugs. We also focused on macrolides, which are commonly prescribed for respiratory tract infections in children but are not appropriate for OM cases.
Methods:
The data were obtained from the electronic health records of about 250,000 annual visits in <18 years old children. The collected variables were all diagnoses, age, visit year, doctor's specialty, and prescribed antibiotics. Children with OM and upper respiratory tract infections were included, but those with lower respiratory tract infections were excluded.
Results:
The number of children with OM was 357,390 (55.2% boys). Antibiotics were prescribed in 44.8% of cases, with the lowest proportion (44.1%) being in <2 years old children. The overall prescription rate decreased from 48.3% in 2014 to 41.4% in 2020. The rates were 19.3% and 18.1% for amoxicillin and 12.6% and 13.2% for amoxicillin-clavulanic acid, respectively. Macrolide prescriptions were reduced from 7.5% to 3.5%. Pediatricians prescribed antibiotics for 38.8%, general practitioners for 54.0% and ear, nose and throat physicians for 39.8% of children with OM.
Conclusion:
The selection of antibiotics for OM, when prescribed, was according to the recommendations (amoxicillin or amoxicillin-clavulanic acid) in 80.1% of pediatricians, 67.0% of general practitioners and 55.1% of ear, nose and throat physicians.
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Etiology
Three primary contributing factors have been identified.