Related Experiment Videos
Antimicrobials prescribed for otitis media in a pediatric Medicaid population
L L White1, T D Holimon, J T Tepedino
1Integrated Pharmacy Solutions, Inc., Memphis, TN, USA.
Insights
Antimicrobial prescribing for children with first-time otitis media (OM) in Tennessee Medicaid often deviated from first-line therapies, costing the state significant amounts. Optimizing antibiotic use for OM could lead to substantial Medicaid savings.
Area of Science:
- Pediatrics
- Pharmacology
- Health Services Research
Background:
- Otitis media (OM) is a common childhood infection requiring antimicrobial treatment.
- Antimicrobial stewardship is crucial for effective treatment and cost containment in pediatric healthcare.
- Understanding prescribing patterns for first-time OM is essential for optimizing therapy.
Purpose of the Study:
- To analyze antimicrobial prescribing patterns for children with their first episode of otitis media (OM) within the Tennessee Medicaid program.
- To identify deviations from recommended first-line therapies and assess their impact on costs.
Main Methods:
- Retrospective analysis of Tennessee Medicaid claims data for children under 11 years old.
- Inclusion criteria: first documented OM diagnosis in Q4 1993 and antimicrobial claim within two days.
- Data analysis focused on prescribed antimicrobials, patient demographics, and associated costs.
Main Results:
- 7357 children met the study criteria; 70% were under three years old.
- Amoxicillin was the most frequent prescription (53%), followed by cefaclor.
- First-line therapies were used in 64% of cases but accounted for only 25% of costs; potential savings of over $68,250 in Q4 1993 alone were identified.
Conclusions:
- Suboptimal antimicrobial prescribing for first-time otitis media in Tennessee Medicaid represents a missed opportunity for cost savings.
- Promoting adherence to first-line therapies for OM could significantly reduce healthcare expenditures for the state.
- Further interventions may be needed to ensure appropriate antimicrobial selection, even in uncomplicated first-time OM cases.
Abstract:
Antimicrobial prescribing patterns for Tennessee Medicaid children having their first case of otitis media (OM) in at least nine months were studied. Tennessee Medicaid claims data for patients under 11 years whose first documented OM diagnosis in 1993 occurred in the fourth quarter and who had had an antimicrobial claim filed within two days of diagnosis were studied to determine antimicrobial prescribing patterns. Of 7357 children meeting the study criteria, 70% were less than three years of age, 65% were Caucasian, and 60% had a rural address. Twenty antimicrobials were prescribed. Amoxicillin was prescribed most frequently (53% of the time), followed by cefaclor; all first-line therapies (amoxicillin, ampicillin, erythromycin-sulfisoxazole, and trimethoprim-sulfamethoxazole) accounted for 64% of the prescriptions, but only one fourth of the costs. The highest use of first-line therapy was associated with children under three years of age; children without prior antimicrobial therapy, recent upper respiratory infection (URI), or recent sinusitis; children seen by emergency department physicians; and children seen by urban physicians. Tennessee Medicaid would have saved +68,250 if first-line therapy had been used for all children having their first occurrence of OM in the fourth quarter alone. The savings to the state were estimated at +300,000 or more in 1993 had first-line therapy been used for most first occurrences of OM in all four quarters plus even a small percentage of the estimated 30,000 remaining repeat OM cases. Amoxicillin was prescribed 53% of the time, and all first-line therapies 64% of the time, for children with their first case of OM in at least nine months. In children without recent antimicrobial therapy, URI, or sinusitis, first-line therapy was still used only 72% of the time.