Abstract
BackgroundOveruse of broad-spectrum antibiotics is associated with antibiotic resistance. Acute otitis media (AOM) is responsible for a large proportion of antibiotics prescribed for US children. Rates of broad-spectrum antibiotic prescribing for AOM are unknown.MethodsAnalysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1998 to 2004 (N = 6,878). Setting is office-based physicians, hospital outpatient departments, and emergency departments. Patients are children aged 12 years and younger prescribed antibiotics for acute otitis media. Main outcome measure is percentage of broad-spectrum antibiotics, defined as amoxicillin/clavulanate, macrolides, cephalosporins and quinolones.ResultsBroad-spectrum prescribing for acute otitis media increased from 34% of visits in 1998 to 45% of visits in 2004 (P < .001 for trend). The trend was primarily attributable to an increase in prescribing of amoxicillin/clavulanate (8% to 15%; P < .001 for trend) and macrolides (9% to 15%; P < .001 for trend). Prescribing remained stable for amoxicillin and cephalosporins while decreasing for narrow-spectrum agents (12% to 3%; P < .001 for trend) over the study period. Independent predictors of broad-spectrum antibiotic prescribing were ear pain, non-white race, public and other insurance (compared to private), hospital outpatient department setting, emergency department setting, and West region (compared to South and Midwest regions), each of which was associated with lower rates of broad-spectrum prescribing. Age and fever were not associated with prescribing choice.ConclusionPrescribing of broad-spectrum antibiotics for acute otitis media has steadily increased from 1998 to 2004. Associations with non-clinical factors suggest potential for improvement in prescribing practice.
Highlights
IntroductionAcute otitis media (AOM) is responsible for a large proportion of antibiotics prescribed for US children
Overuse of broad-spectrum antibiotics is associated with antibiotic resistance
Broad-spectrum antibiotics were prescribed in 41% (2839/6878) and amoxicillin was prescribed in 56% (3880/6878) of visits in which an antibiotic was prescribed (Table 1)
Summary
Acute otitis media (AOM) is responsible for a large proportion of antibiotics prescribed for US children. Rates of broad-spectrum antibiotic prescribing for AOM are unknown. It is important to avoid unnecessary pediatric antibiotic use because children represent a large reservoir for resistant organisms [3]. Acute otitis media (AOM) accounts for up to 40% to 50% of antibiotics prescribed for United States children less than 2 years of age [4]. Cian is randomly assigned to a one-week reporting period. During this period, data for a systematic random sample of visits is recorded by the physician or office staff on a standardized encounter form provided for that purpose and checked for completeness by NCHS field staff. Physicians in the sample complete 30 records over a one week period
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