Improvement in the appropriate antimicrobial usage for treating pediatric acute otitis media in Japan: A descriptive study using nation-wide electronic medical record data

Masamitsu Kono,Gen Sugita,Koju Itahashi,Yuji Sasagawa,Yasuhiro Iwama,Shuichi Hiraoka,Makiko Ohtani,Muneki Hotomi

doi:10.1016/j.jiac.2021.05.013

Masamitsu Kono, Gen Sugita + Show 6 more

Open Access

https://doi.org/10.1016/j.jiac.2021.05.013

Copy DOI

Abstract

ObjectivesWe investigated changes in prescriptions for antimicrobial agents to treat children with acute otitis media (AOM). MethodsA descriptive study using an electronic medical record database. Of 199,896 patients enrolled between 2001 and 2019, a total of 10,797 were aged <16 years and had AOM as their first and primary disease (overall pediatric AOM cohort). In addition, 4786 patients with AOM without other comorbidities (pediatric AOM cohort) were included. ResultsIn the overall pediatric AOM cohort, the age distribution ranged from 11% to 23% for those younger than 2 years and from 66% to 77% for those younger than 6 years, with no change over time. In the pediatric AOM cohort, the antimicrobial prescription rate was 91% in 2001 but declined to 40% by 2019. Antimicrobial use increased from 0% to 75% for penicillins, whereas use of cephalosporins decreased from 84% to 10%. The prescription rate for acetaminophen alone increased from 33% to 58%. There were no differences in the incidence of adverse reactions among the prescribed antimicrobials. ConclusionsDue to education efforts and promotion of the proper use of antimicrobials through means such as the Clinical practice guidelines for the diagnosis and management of acute otitis media in children (2006) and the Manual of Antimicrobial Stewardship (2016), a change in the use of antimicrobials occurred, leading to a trend to more proper use of these agents.

Highlights

Acute otitis media (AOM) is one of the most common infections for which antimicrobials are prescribed [1,2]
4786 pediatric patients with AOM without concomitant dis eases were selected as the pediatric AOM cohort (Fig. 1)
Regarding the background of patients included in the pediatric AOM cohort, 2655 (55.5%) were male and 2131 (44.5%) were female, and the gender ratio remained unchanged each year

Summary

Introduction

Acute otitis media (AOM) is one of the most common infections for which antimicrobials are prescribed [1,2]. Sixty-two percent of children will have AOM at least once by 1 year of age and 17% will have it at least three times, and 83% will have it at least once by 3 years of age [3]. AOM accounts for ~16.8% of pediatric patients [4]. In Japan, ~4.3% of children visiting medical facilities have AOM [5,6]. AOM can cause hearing loss in infants and toddlers and delay speech and/or voice acquisition and development of cognitive functions [7,8]. Given the high prevalence and developmental impact of AOM, evidence-based guidelines for pediatric patients have been advocated in many coun tries [9,10,11]

Objectives

Methods

Results

Conclusion