Improving Guideline-concordant Antibiotic Use for Acute Otitis Media in a Pediatric Primary Care Network

Maintenance of Certification (MOC) projects have previously been shown to improve diagnostic accuracy and infection treatment in inpatient settings.

We developed and delivered an MOC project in our ambulatory care network in 2023 to increase the use of American Academy of Pediatrics guideline-concordant antibiotic selection and duration for the treatment of acute otitis media (AOM), including amoxicillin for most patients, and the use of shorter (5-7 d) antibiotic durations in children over 2 years with nonsevere symptoms. We evaluated the use of guideline-concordant antibiotics across the network from January 2021 to September 2025, including periods before, during, and after the MOC intervention. We compared the use of guideline-concordant antibiotics between clinics that participated in the MOC intervention and those that did not.

The study period included 40,329 AOM episodes. By the end of the study period, 64.7% of children with AOM across the network received guideline-concordant antibiotic selection and duration, up from 46.6% at baseline. After the intervention, MOC-participating clinics had increased use of guideline-concordant antibiotic selection and duration compared to nonparticipating clinics (70.1% versus 54.5%). The frequency of patients returning within 7 days for a repeat AOM visit did not differ between the baseline period (124/12,735; 1.0%) and the postintervention period (303/27,594; 1.1%) (P = 0.3).

An MOC program was effective in increasing guideline-concordant antibiotic prescriptions for pediatric AOM across an outpatient network. This effect persisted over time and was stronger in MOC-participating clinics. MOC participation has the potential to improve antibiotic stewardship in ambulatory settings.