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Trends in antibiotic treatment of acute otitis media and treatment failure in children, 2000-2011.

McGrath LJ, Becker-Dreps S, Pate V, Brookhart MA - PLoS ONE (2013)

Bottom Line: The proportion of antibiotic dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of dispensing rebounded to pre-guideline levels.Antibiotic failure decreased slightly, and macrolides had the lowest proportion of failures, while all other classes had failure rates around 10%.Overprescribing of antibiotics and use of non-penicillin therapy for AOM treatment could lead to the development of antibiotic-resistant infections.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America.

ABSTRACT

Objectives: Guidelines to treat acute otitis media (AOM) were published in 2004. Initial declines in prescribing were shown, but it's unknown if they were sustained. We examine trends in antibiotic dispensing patterns to treat AOM among a large population of children. We also document trends in antibiotic failure.

Study design: Children aged 3 months to 12 years with an AOM diagnosis, enrolled in a commercial claims database between January 1, 2000-December 31, 2011 were included. Pharmacy claims within 7 days of diagnosis were searched for antibiotic prescriptions. Antibiotic failure was defined as a dispensing of a different antibiotic class within 2-18 days after the first prescription. We analyzed trends in antibiotic use and failure by class of antibiotic and year.

Results: We identified over 4 million children under 13 years with AOM. The proportion of antibiotic dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of dispensing rebounded to pre-guideline levels. However, levels began decreasing again in 2010 and the antibiotic use rate in 2011 was 57.6%. Cephalosporin prescriptions increased by 41.5% over eleven years. Antibiotic failure decreased slightly, and macrolides had the lowest proportion of failures, while all other classes had failure rates around 10%.

Conclusions: In recent years, antibiotic dispensing to treat AOM remains high. In addition, the use of broad-spectrum antibiotics is increasing despite having a high rate of treatment failure. Overprescribing of antibiotics and use of non-penicillin therapy for AOM treatment could lead to the development of antibiotic-resistant infections.

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Related in: MedlinePlus

Initial dispensed antibiotics to treat acute otitis media among children, by age (Panel A) and antibiotic type (Panel B).
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pone-0081210-g001: Initial dispensed antibiotics to treat acute otitis media among children, by age (Panel A) and antibiotic type (Panel B).

Mentions: Over the 12 year period, 60.1% of children with AOM diagnoses were dispensed antibiotics. The proportion of dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of antibiotic dispensing rebounded to pre-AAP/AAFP guideline levels. However, levels began decreasing again in 2010 and antibiotic use in 2011 was 57.6%. Of all antibiotics dispensed, 54% were for amoxicillin. Use of amoxicillin decreased slightly – from 57% to 53% between 2005–2008, but increased to pre-guideline levels by 2011 (Figure 1A). This trend was seen in children of all ages, although children 2 years and older had slightly less antibiotic use.


Trends in antibiotic treatment of acute otitis media and treatment failure in children, 2000-2011.

McGrath LJ, Becker-Dreps S, Pate V, Brookhart MA - PLoS ONE (2013)

Initial dispensed antibiotics to treat acute otitis media among children, by age (Panel A) and antibiotic type (Panel B).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3852237&req=5

pone-0081210-g001: Initial dispensed antibiotics to treat acute otitis media among children, by age (Panel A) and antibiotic type (Panel B).
Mentions: Over the 12 year period, 60.1% of children with AOM diagnoses were dispensed antibiotics. The proportion of dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of antibiotic dispensing rebounded to pre-AAP/AAFP guideline levels. However, levels began decreasing again in 2010 and antibiotic use in 2011 was 57.6%. Of all antibiotics dispensed, 54% were for amoxicillin. Use of amoxicillin decreased slightly – from 57% to 53% between 2005–2008, but increased to pre-guideline levels by 2011 (Figure 1A). This trend was seen in children of all ages, although children 2 years and older had slightly less antibiotic use.

Bottom Line: The proportion of antibiotic dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of dispensing rebounded to pre-guideline levels.Antibiotic failure decreased slightly, and macrolides had the lowest proportion of failures, while all other classes had failure rates around 10%.Overprescribing of antibiotics and use of non-penicillin therapy for AOM treatment could lead to the development of antibiotic-resistant infections.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America.

ABSTRACT

Objectives: Guidelines to treat acute otitis media (AOM) were published in 2004. Initial declines in prescribing were shown, but it's unknown if they were sustained. We examine trends in antibiotic dispensing patterns to treat AOM among a large population of children. We also document trends in antibiotic failure.

Study design: Children aged 3 months to 12 years with an AOM diagnosis, enrolled in a commercial claims database between January 1, 2000-December 31, 2011 were included. Pharmacy claims within 7 days of diagnosis were searched for antibiotic prescriptions. Antibiotic failure was defined as a dispensing of a different antibiotic class within 2-18 days after the first prescription. We analyzed trends in antibiotic use and failure by class of antibiotic and year.

Results: We identified over 4 million children under 13 years with AOM. The proportion of antibiotic dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of dispensing rebounded to pre-guideline levels. However, levels began decreasing again in 2010 and the antibiotic use rate in 2011 was 57.6%. Cephalosporin prescriptions increased by 41.5% over eleven years. Antibiotic failure decreased slightly, and macrolides had the lowest proportion of failures, while all other classes had failure rates around 10%.

Conclusions: In recent years, antibiotic dispensing to treat AOM remains high. In addition, the use of broad-spectrum antibiotics is increasing despite having a high rate of treatment failure. Overprescribing of antibiotics and use of non-penicillin therapy for AOM treatment could lead to the development of antibiotic-resistant infections.

Show MeSH
Related in: MedlinePlus