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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

Antibiotic failure among children with an acute otitis media diagnosis by age categories (Panel A) and initial antibiotic type (Panel B).
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pone-0081210-g002: Antibiotic failure among children with an acute otitis media diagnosis by age categories (Panel A) and initial antibiotic type (Panel B).

Mentions: Among children with AOM and with one initial prescription, 10.1% required an additional antibiotic within 2–18 days over the 12 year period (Table 2). Antibiotic failure decreased slightly over time (p = 0.03) and only 9.6% required a second prescription in 2011 (Figure 2). Children less than 2 years of age had the highest levels of failure (Figure 2A). Cephalosporins, amoxicillin/clavulanate and amoxicillin had similar failure proportions, while macrolides had a lower failure rate (p<0.0001) (Table 2); however, all antibiotic classes had a similar decline over time (Figure 2B). When children with diagnosis codes for other infections were excluded (N = 3,731), the failure proportions were similar (data not shown). Among children requiring only one antibiotic for the second dispensing, cephalosporins were the most common second prescription (37.7%) and the majority of children who received amoxicillin, amoxicillin/clavulanate and macrolides as first agents were switched to a cephalosporin (Table 3). For those started on a cephalosporin, the majority were switched to amoxicillin/clavulanate. Among children who experienced a treatment failure with one initial therapy, 6.4% received multiple (2 or more) antibiotics in subsequent dispensings.


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)

Antibiotic failure among children with an acute otitis media diagnosis by age categories (Panel A) and initial antibiotic type (Panel B).
© Copyright Policy
Related In: Results  -  Collection

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

pone-0081210-g002: Antibiotic failure among children with an acute otitis media diagnosis by age categories (Panel A) and initial antibiotic type (Panel B).
Mentions: Among children with AOM and with one initial prescription, 10.1% required an additional antibiotic within 2–18 days over the 12 year period (Table 2). Antibiotic failure decreased slightly over time (p = 0.03) and only 9.6% required a second prescription in 2011 (Figure 2). Children less than 2 years of age had the highest levels of failure (Figure 2A). Cephalosporins, amoxicillin/clavulanate and amoxicillin had similar failure proportions, while macrolides had a lower failure rate (p<0.0001) (Table 2); however, all antibiotic classes had a similar decline over time (Figure 2B). When children with diagnosis codes for other infections were excluded (N = 3,731), the failure proportions were similar (data not shown). Among children requiring only one antibiotic for the second dispensing, cephalosporins were the most common second prescription (37.7%) and the majority of children who received amoxicillin, amoxicillin/clavulanate and macrolides as first agents were switched to a cephalosporin (Table 3). For those started on a cephalosporin, the majority were switched to amoxicillin/clavulanate. Among children who experienced a treatment failure with one initial therapy, 6.4% received multiple (2 or more) antibiotics in subsequent dispensings.

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