OBJECTIVES: To determine the prescribing patterns and expenditures for otitis media (OM)-related antibiotics in the Texas Medicaid pediatric population, and identify the demographic and antibiotic-related factors associated with expensive prescriptions for OM-related antibiotics. METHODS: This retrospective study used Texas Medicaid outpatient medical and prescription claims data for children younger than 13 years old with a diagnosis of OM (ICD-9: 381.0-382.0) and claims for OM-related antibiotics from January 2008 to December 2011. OM-related antibiotics were selected based on the guidelines proposed by the American Academy of Pediatrics and the American Academy of Family Physicians in 2004, and were classified into three categories: cephalosporins, macrolides and penicillins (amoxicillin, amoxicillin-clavulanate). The total number (proportion) of prescriptions and costs were compared across selected antibiotics and categories. Generalized linear model was used to evaluate potential factors associated with expensive prescriptions. RESULTS: CONCLUSIONS: Prescription claims and expenditures for selected OM-related antibiotics declined between 2008 and 2011 in the Texas Medicaid pediatric population.