The Otitis Media Treatment Index: A Measure of Antibiotic Stewardship in Pediatric Otitis Media

Otitis media (OM) is the most common reason for pediatric antibiotic prescriptions, but is frequently misdiagnosed, leading to unnecessary antibiotic use. Quality improvement efforts are hampered by the lack of an accepted measure of OM-specific antimicrobial stewardship.

Using 2 years of data from a statewide pediatric primary care network, we developed the Otitis Media Treatment Index (OMTI), a peer-comparison metric of the judiciousness of OM diagnosis and treatment in young children. The OMTI is defined as the proportion of encounters for children 6 to 59 months of age with a diagnosis of an acute respiratory illness for which any OM diagnosis was made and an antibiotic was prescribed. We analyzed the variability in the OMTI among individual clinicians, its year-to-year stability, and its association with various demographic factors.

Four hundred and eighty-seven clinicians were included in the analysis. In 2023, among 161,593 encounters with a respiratory illness, 42,613 had a diagnosis of OM and an antibiotic prescribed, yielding an OMTI of 26.4% (range for individual clinicians: 3.3-58.8%). In 2024, among 150,781 qualifying encounters, 38,096 had a diagnosis of OM and an antibiotic prescribed, yielding an OMTI of 25.3% (range for individual clinicians: 3.8-54.3%). The interclass correlation coefficient for individual clinicians between 2023 and 2024 was 0.82.

The OMTI, a measure of the proportion of encounters among young children with a respiratory illness during which OM is diagnosed and treated with an antibiotic, is a readily understandable and easily calculated metric of the judiciousness of OM diagnosis and treatment in ambulatory pediatric settings.