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Differences in Antibiotic Prescribing Patterns for Children with Acute Otitis Media Based on Patient, Clinician, and
Alexander S Plattner1,2, Sonja O'Leary3,4, Sophie E Katz5
1WashU Medicine, Department of Pediatrics, Division of Infectious Diseases, St. Louis, MO, United States.
Insights
Children with acute otitis media (AOM) received more antibiotics if they were not White or Hispanic. Shorter antibiotic courses were prescribed to these children, influenced by clinician prescribing patterns.
Area of Science:
- Pediatrics
- Health Services Research
- Infectious Diseases
Background:
- Antibiotic prescribing for common childhood infections varies by patient background.
- Data on acute otitis media (AOM) management disparities are limited.
- Understanding these disparities is crucial for equitable pediatric care.
Purpose of the Study:
- To evaluate antibiotic prescribing rates and treatment durations for children with uncomplicated AOM.
- To identify patient, clinician, and clinic factors influencing AOM management.
- To address potential inequities in pediatric antibiotic use.
Main Methods:
- Retrospective analysis of health records from 123 sites across two health systems (2019-2022).
- Examined antibiotic prescription status and duration for children over 2 years old with AOM.
- Statistical analyses assessed variations in prescribing based on patient, clinician, and clinic characteristics.
Main Results:
- Children identifying with races other than White, Hispanic, or with public insurance were more likely to receive antibiotics (87-88% vs. 82-83%).
- Mean antibiotic treatment duration was ~9 days for all groups.
- Shorter antibiotic courses were significantly associated with non-White, Hispanic, non-English speaking, and publicly insured children.
Conclusions:
- Children with AOM from minority racial/ethnic groups or with public insurance received antibiotics more frequently.
- Shorter antibiotic durations were more common in these populations, linked to clinician prescribing habits.
- Clinicians serving these populations tended to prescribe shorter courses to all patients, indicating a systemic influence on treatment duration.
Objectives:
Children with common infections receive varying care based on their backgrounds; however, data for acute otitis media (AOM) management are limited. Our study aimed to evaluate differences in antibiotic prescribing rate and treatment duration for children (≥2 years) with uncomplicated AOM based on patient, clinician, and clinic characteristics.
Methods:
Retrospective study of health record data from two health systems (123 total sites) from 2019 to 2022. Primary outcomes included: (1) whether an antibiotic was prescribed, and (2) if so, the duration prescribed. Analyses were performed to assess whether differences in prescribing occurred among individual patients, clinicians, or clinics.
Results:
Among 66,382 encounters for AOM, children who were races other than White, Hispanic, or had public insurance or self-pay were more likely to be prescribed an antibiotic than children who were White (87% vs. 83%, OR 1.43 [1.12, 1.84]), non-Hispanic (88% vs. 82%, OR 1.54 [1.06, 2.23]), or had commercial/private insurance (87% vs. 83%, OR 1.35 [1.10, 1.67]). The mean treatment duration was ~9 days for all groups, however statistical significance was seen with shorter courses for children who were races other than White, Hispanic, had a primary language other than English, or had public insurance or self-pay. Duration differences were seen among clinicians, with those who prescribed the shortest durations seeing, on average, a greater proportion of children who were races other than White, Hispanic, spoke a non-English primary language, and had public insurance or self-pay.
Conclusions:
Children with AOM who were races other than White, Hispanic, or had public insurance or self-pay were more likely to be prescribed an antibiotic. However, shorter durations were more common among these children, primarily because clinicians serving this population tended to prescribe shorter durations to all patients, regardless of child sociodemographic characteristics.
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