Durations of Antibiotic Treatment for Acute Otitis Media and Variability in Prescribed Durations Across Two Large Academic Health Systems

Abstract

Background: Acute otitis media (AOM) accounts for roughly 25% of antibiotics prescribed to children annually. Despite national guidelines that recommend short (5-7 days) durations of antibiotics for children 2 years and older with AOM, most receive long (10 day) courses. This study aims to evaluate antibiotic durations prescribed for children aged 2-17 years with uncomplicated AOM across two pediatric academic health systems, and to assess the variability in prescribed durations between and within each system.

Methods: Electronic medical record data from 135 care locations at two health systems were retrospectively analyzed. Outpatient encounters for children aged 2-17 years with a diagnosis of AOM from 2019 to 2022 were included. The primary outcome was the percent of 5-day prescriptions. Secondary outcomes included the proportion of 7-day prescriptions, 10-day prescriptions, prescriptions for nonfirst-line antibiotics, cases associated with treatment failure, AOM recurrence, and adverse drug events.

Results: Among 73 198 AOM encounters for children 2 years and older, 61 612 (84%) encounters resulted in an antibiotic prescription. Most prescriptions were for 10 days (45 689; 75%), 20% were for 7 days (12 060), and only 5% were for 5 days (3144). Treatment failure, AOM recurrence, adverse drug events, hospitalizations, and office, emergency department or urgent-care visits for AOM within 30 days after the index visit were rare.

Conclusions: Despite national guidelines that recommend shorter durations for children with uncomplicated AOM, 75% of our cohort received 10-day durations. Shortening durations of therapy for AOM could reduce antibiotic exposure and should be a priority of pediatric antibiotic stewardship programs.

Keywords: acute otitis media; antibiotic stewardship; duration of therapy; pediatrics.

Figure 1.

Study cohort description.

Figure 2.

Proportion of antibiotics prescribed for 5, 7, 10, or 14+ days, by care location and health system. Proportion of encounters with 5-, 7-, 10-, or 14+ duration of antibiotics at each health system and by care location (convenient/walk-in/after hours, emergency department [ED], medical specialty clinic [otolaryngology, allergy/immunology, and pulmonary], primary care clinic, or retail health clinic). Washington University does not have any sites that qualify as retail health clinics thus the absence of data in that panel.

Figure 3.

(a) Variability in antibiotic duration by care location. Each line represents a separate care location. The point represents the mean duration prescribed and the line ranges from the minimum to the maximum duration prescribed across all encounters. Care locations include primary care clinics, convenient/walk-in/after-hours clinics, emergency departments (ED), retail health clinics, and medical specialty clinics. (b) Variability in antibiotic duration by clinician. Each line represents a separate clinician. The point represents the mean duration prescribed and the line ranges from the minimum to the maximum duration prescribed across all encounters. Clinicans are grouped by 10-100 encounters, 100-500 encounters and greater than 500 encounters. (c) Variability in antibiotic duration by clinician type. Each line represents a separate clinician. The point represents the mean duration prescribed and the line ranges from the minimum to the maximum duration prescribed across all encounters. Clinician types include physicians, nurse practitioners, physician assistants, and “other” clinicians.

Figure 3.

(a) Variability in antibiotic duration by care location. Each line represents a separate care location. The point represents the mean duration prescribed and the line ranges from the minimum to the maximum duration prescribed across all encounters. Care locations include primary care clinics, convenient/walk-in/after-hours clinics, emergency departments (ED), retail health clinics, and medical specialty clinics. (b) Variability in antibiotic duration by clinician. Each line represents a separate clinician. The point represents the mean duration prescribed and the line ranges from the minimum to the maximum duration prescribed across all encounters. Clinicans are grouped by 10-100 encounters, 100-500 encounters and greater than 500 encounters. (c) Variability in antibiotic duration by clinician type. Each line represents a separate clinician. The point represents the mean duration prescribed and the line ranges from the minimum to the maximum duration prescribed across all encounters. Clinician types include physicians, nurse practitioners, physician assistants, and “other” clinicians.

Figure 3.

(a) Variability in antibiotic duration by care location. Each line represents a separate care location. The point represents the mean duration prescribed and the line ranges from the minimum to the maximum duration prescribed across all encounters. Care locations include primary care clinics, convenient/walk-in/after-hours clinics, emergency departments (ED), retail health clinics, and medical specialty clinics. (b) Variability in antibiotic duration by clinician. Each line represents a separate clinician. The point represents the mean duration prescribed and the line ranges from the minimum to the maximum duration prescribed across all encounters. Clinicans are grouped by 10-100 encounters, 100-500 encounters and greater than 500 encounters. (c) Variability in antibiotic duration by clinician type. Each line represents a separate clinician. The point represents the mean duration prescribed and the line ranges from the minimum to the maximum duration prescribed across all encounters. Clinician types include physicians, nurse practitioners, physician assistants, and “other” clinicians.