OBJECTIVES: To evaluate utilization patterns and healthcare costs among children in Texas Medicaid diagnosed with otitis media (OM), and analyze the relationship between index antibiotic medication and prevalence of persistent OM (POM). METHODS:  A retrospective analysis of Texas Medicaid outpatient medical and prescription claims from July 2007 to August 2011 for beneficiaries (0-18 years) with an OM diagnosis (ICD-9: 381-382) and an associated antibiotic medication was conducted.  POM was defined as having a subsequent OM diagnosis within 45 days after starting the index antibiotic medication.  OM-related costs were compared across medications and logistic regression was used to evaluate POM likelihood by medication with demographics and costs as covariates.  Utilization patterns will be described graphically using data visualization. RESULTS:  The study sample included 307,107 patients with a mean age of 3.0 years (SD=3.8), a majority being male (51.9%), Hispanic (63.8%), and from an urban region (84.3%).  The overall prevalence of POM was 19.3%.  Total mean OM episode-related costs were 2.0 times higher for POM patients compared to non-POM patients, and the total OM-related cost to Medicaid was approximately $58 million.  Four index antibiotics (noting their associated POM prevalence) were studied: amoxicillin (19.0%), amoxicillin-clavulanate (21.2%), azithromycin (15.1%), and cefdinir (21.4%).  The second least expensive index medication (azithromycin) had the lowest POM prevalence (15.1%) and the second lowest mean total OM-related costs ($194; SD=$313).  Mean outpatient costs were similar between patients taking amoxicillin and cefdinir (the least and most expensive medications, respectively), while amoxicillin-clavulanate and azithromycin patients’ outpatient costs were significantly higher (p<0.01).  Age, race, Texas region, index medication, and index medication cost category (low vs. high) were significant predictors (p<0.01) of a POM episode. CONCLUSIONS:  The data suggest different POM prevalence among index antibiotic medications, with POM patients accounting for a disproportionally higher portion of OM-related healthcare costs.