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Black children more likely to receive narrow-spectrum antibiotics for otitis media
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Black children diagnosed with otitis media during an ambulatory care visit were more likely to receive guideline-recommended narrow-spectrum antibiotics than nonblack children, according to study results.
The researchers noted that these findings raise concerns that differences in care based on race also may reflect inappropriate treatment of otitis media with the overuse of broad-spectrum antibiotics in a majority of children.
“Overtreatment and overdiagnosis in white children could result from the possibility that in some circumstances, parents may expect an antibiotic prescription, or physicians may perceive that they do,” researcher Adam L. Hersh, MD, PhD, assistant professor of pediatrics, University of Utah School of Medicine, said in a press release. “Physicians may tailor their diagnosis based on these perceptions of patient expectations.”
Adam L. Hersh
To assess whether race was a contributing factor in diagnosis and antibiotic prescription, Hersh and colleagues examined otitis media visit rates during 2008 to 2010 for children aged 14 years and younger using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. They compared visits between black and nonblack children, then compared antibiotic prescription by race as the percentage of otitis media visits receiving narrow-spectrum, such as amoxicillin, vs. broader-spectrum antibiotics. The researchers used multivariable logistic regression to determine whether race was independently linked with antibiotic selection for otitis media.
Once diagnosed with otitis media, black children were 20% less likely than nonblack children to receive a prescription for broad-spectrum antibiotics (P=.01). These findings indicate that black children are more likely to receive care that adheres to national otitis media treatment guidelines from the AAP and American Academy of Family Physicians.
Researchers said the percentage of all visits resulting in otitis media diagnosis was 30% lower in black children vs. white children (7% vs. 10%; P=.004). Otitis media visits per 1,000 population, however, were similar between black and nonblack children (253 vs. 321; P=.12).
Possible contributing factors for the racial disparities in care included differences in the frequency of parents seeking care for children with respiratory infections or return for follow-up visits.
In addition, researchers said children receiving care in an ED were more likely to receive guideline-recommendation antibiotics for otitis media, indicating that office-based physicians may be more predisposed to perceived parent demand for antibiotics as well as concerns about parent satisfaction and patient retention.
“These findings raise the possibility that physicians bring with them to the exam room cultural and racial biases that influence how they make a diagnosis and prescribe antibiotics,” Hersh said.
Disclosure: The researchers report no relevant financial disclosures.
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