Prescribing Patterns and Retreatment Rates in Patients with Otitis Media
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Clin Drug Invest 2002; 22 (5): 303-311 1173-2563/02/0005-0303/$25.00/0 © Adis International Limited. All rights reserved.
Prescribing Patterns and Retreatment Rates in Patients with Otitis Media T.I. Shireman1 and K.A. Kelsey2 1 University of Kansas School of Pharmacy, Lawrence, Kansas, USA 2 University of Utah Health Network, Midvale, Utah, USA
Abstract
Objective: 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. Design/setting: A retrospective cohort review of Ohio Medicaid medical and prescription claims. Patients: The study population included continuously enrolled children 7 years of age or younger with a new onset diagnosis of acute nonsuppurative or suppurative 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. Main outcome measures: Primary outcome measures included antibiotic treatment rates, likelihood of receiving amoxicillin as initial treatment, and retreatment, and were modelled using logistic regression analysis. Results: Over 75% of the 9177 cases were treated empirically with an antibiotic prescription. The most commonly prescribed antibiotic was amoxicillin. AfricanAmerican 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 0.890.93) 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). Conclusion: 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.
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Otitis media (OM) is one of the most common diagnoses to be treated with antimicrobials in the paediatric population, accounting for over 25% of the oral antibiotics prescribed annually.[1-3] Within the United States, where physicians prescribe antibiotics for the majority of ambulatory visits for OM, antibiotic choices vary widely.[4,5] Provider factors (specialty, practice setting or region) and patient factors (age, race and gender) have been shown to influence antibiotic choice for OM cases.[4-8] Over the last decade, a few newer, broadspectrum antibiotics have become available, expanding the antibiotic choices for treatment of OM.[9,10] These agents are four to ten times more expensive than amoxicillin,[6] but their added expense is not necessarily indicative o
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