BACKGROUND

Acute otitis media (AOM) in children is commonly treated with antibiotics, yet limited data of prescribing patterns and the outcomes exists.

OBJECTIVES

: Document factors affecting antibiotic prescribing patterns for pediatric AOM patients and estimate the effects of antibiotic prescribing on the likelihood of revisits within 28 days.

METHODS

: Optum Insight Clinformatics claims data from 2011-2013 were used to identify children (<18 years old) diagnosed with AOM. An episode of care was defined around the first AOM visit (+/- 6 months). Multivariable logistic regression was used to identify demographic and clinical factors associated with antibiotic use. A similar model was used to estimate the effect of treatment on the likelihood of initiating a revisit within 28 days.

RESULTS

: 2378 (64%) of 3747 children with AOM were treated with an antimicrobial within 28 days, and only 57% of treated patients had their antibiotic prescription filled within 3 days. The likelihood of filling within 3 days increased with age and co-morbid fever or URI, and was lower among patients with a prior respiratory infection.

Children receiving the antibiotic within 3 days had a reducedrisk of a revisit within 28 days (adjusted OR=0.439, p<0.001) than those who received the antibiotic in 4-28 days, or who were not treated. Children receiving an antibiotic on the index visit day had 62% lower risk of a revisit (p<0.001) within 28 days than the children who were not treated.Children < 1 year old were 2.4 times more likely to initiate a revisit. Class of antibiotic prescribed did not impact revisit risk. The statistical factors and magnitude were similar for revisits within 7 and 28 days.

CONCLUSIONS

: AOM patients filling an antibiotic prescription on or within 3 days of the index visit are less likely to initiate a return visit within 7 to 28 days.