Prescribing Patterns and Retreatment Rates in Patients with Otitis Media

Abstract

To explore factors leading to the treatment of acute-onset otitis media (OM) and determine the effect of antibiotic choice on retreatment rates in a paediatric Medicaid population. A retrospective cohort review of Ohio Medicaid medical and prescription claims. The study population included continuously enrolled children 7 years of age or younger with a new onset diagnosis of acute nonsuppurative or suppu-rative OM during a 3-month period and followed for 30 days post-diagnosis. Claims were screened for the presence of other upper respiratory infections (URI) and chronic OM. Primary outcome measures included antibiotic treatment rates, likelihood of receiving amoxicillin as initial treatment, and retreatment, and were modelled using logistic regression analysis. Over 75% of the 9177 cases were treated empirically with an antibiotic prescription. The most commonly prescribed antibiotic was amoxicillin. African-American children [confidence interval for adjusted odds (CI) 1.04–1.43], children with a suppurative diagnosis (CI 1.83–2.24), and those with a concurrent URI (CI 1.36–1.86) were more likely to receive an antibiotic. Furthermore, African-American (CI 1.46–1.95) and Hispanic children (CI 1.04–2.18) were more likely to receive amoxicillin. Retreatment rates declined with age (CI 0.89–0.93) and were lower for African-Americans (CI 0.61–0.83) and children who received a sulfa drug (CI 0.64–0.95) or amoxicillin (CI 0.62–0.79). The decision to use antibiotics in the treatment of OM was primarily influenced by the type of OM diagnosis. Amoxicillin and sulfa drugs were the most effective agents. These results were consistent with and strongly supported the United States national guidelines to avoid empirical antibiotic treatment or to choose narrow-spectrum agents like amoxicillin for initial treatment of acuteonset OM.