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J Pediatr. 2020 Feb 25. pii: S0022-3476(20)30116-5. doi: 10.1016/j.jpeds.2020.01.045. [Epub ahead of print]

Antibiotic Prescribing Patterns for Acute Otitis Media for Children 2 Years and Older.

Author information

1
Department of Pediatrics, Denver Health Medical Center, Denver, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. Electronic address: Holly.Frost@dhha.org.
2
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
3
Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO.
4
Department of Pharmacy, Denver Health Medical Center, Denver, CO.
5
Division of Infectious Diseases and Department of Medicine, Denver Health Medical Center, Denver, CO; Department of Internal Medicine-Infectious Diseases, University of Colorado School of Medicine, Aurora, CO.

Abstract

OBJECTIVE:

To determine the frequency that non-first-line antibiotics, safety-net antibiotic prescriptions (SNAPS), and longer than recommended durations of antibiotics were prescribed for children ≥2 years of age with acute otitis media and examine patient and system level factors that contributed to these outcomes.

STUDY DESIGN:

Children age ≥2 years with acute otitis media seen at Denver Health Medical Center outpatient locations from January to December 2018 were included. The percentages of patients who received first-line antibiotics, SNAPs, and recommended durations of antibiotics were determined. Factors associated with non-first-line and longer than recommended antibiotic durations were evaluated using multivariate logistic regression modeling.

RESULTS:

Of the 1025 visits evaluated, 98.0% were prescribed an antibiotic; only 4.5% of antibiotics were SNAPs. Non-first-line antibiotics were prescribed to 18.8% of patients. Most antibiotic durations (94.1%) were longer than the institution recommended 5 days and 54.3% were ≥10 days. Private insurance was associated with non-first-line antibiotics (aOR, 1.89; 95% CI, 1; 14-3.14, P = .01). Patients who were younger (2-5 years; aOR 2.01; 95% CI, 1.32-3.05; P < .001) or seen in emergency/urgent care sites (aOR, 1.73; 95% CI, 1.26-2.38; P < .001) were more likely to receive ≥10 days of antibiotic compared with those in pediatric clinics.

CONCLUSIONS:

Antibiotic stewardship interventions that emphasize the duration of antibiotic therapy as well as the use of SNAPs or observation may be higher yield than those focusing on first-line therapy alone. Numerous system and patient level factors are associated with off-guideline prescribing.

KEYWORDS:

acute otitis media; antimicrobial stewardship; children; duration; treatment

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