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Antibiotic Prescribing Patterns for Acute Otitis Media for Children 2 Years and Older.

Authors
  • Frost, Holly M1
  • Becker, Lauren F2
  • Knepper, Bryan C3
  • Shihadeh, Katherine C4
  • Jenkins, Timothy C5
  • 1 Department of Pediatrics, Denver Health Medical Center, Denver, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. Electronic address: H[email protected]
  • 2 Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
  • 3 Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO.
  • 4 Department of Pharmacy, Denver Health Medical Center, Denver, CO.
  • 5 Division of Infectious Diseases and Department of Medicine, Denver Health Medical Center, Denver, CO; Department of Internal Medicine-Infectious Diseases, University of Colorado School of Medicine, Aurora, CO.
Type
Published Article
Journal
The Journal of pediatrics
Publication Date
May 01, 2020
Volume
220
Identifiers
DOI: 10.1016/j.jpeds.2020.01.045
PMID: 32111379
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To determine the frequency that non-first-line antibiotics, safety-net antibiotic prescriptions (SNAPS), and longer than recommended durations of antibiotics were prescribed for children ≥2 years of age with acute otitis media and examine patient and system level factors that contributed to these outcomes. Children age ≥2 years with acute otitis media seen at Denver Health Medical Center outpatient locations from January to December 2018 were included. The percentages of patients who received first-line antibiotics, SNAPs, and recommended durations of antibiotics were determined. Factors associated with non-first-line and longer than recommended antibiotic durations were evaluated using multivariate logistic regression modeling. Of the 1025 visits evaluated, 98.0% were prescribed an antibiotic; only 4.5% of antibiotics were SNAPs. Non-first-line antibiotics were prescribed to 18.8% of patients. Most antibiotic durations (94.1%) were longer than the institution recommended 5 days and 54.3% were ≥10 days. Private insurance was associated with non-first-line antibiotics (aOR, 1.89; 95% CI, 1; 14-3.14, P = .01). Patients who were younger (2-5 years; aOR 2.01; 95% CI, 1.32-3.05; P < .001) or seen in emergency/urgent care sites (aOR, 1.73; 95% CI, 1.26-2.38; P < .001) were more likely to receive ≥10 days of antibiotic compared with those in pediatric clinics. Antibiotic stewardship interventions that emphasize the duration of antibiotic therapy as well as the use of SNAPs or observation may be higher yield than those focusing on first-line therapy alone. Numerous system and patient level factors are associated with off-guideline prescribing. Copyright © 2020 Elsevier Inc. All rights reserved.

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