Most children receive too many antibiotics for ear infections, study finds

Key takeaways:

• The AAP published guidelines in 2013 encouraging shorter antibiotic durations for acute otitis media.
• Three-quarters of providers are still prescribing 10-day antibiotic courses for the condition.

Most providers are still prescribing 10-day courses of antibiotics for acute otitis media despite recommendations calling for shorter durations of treatment, according to study findings.

As Healio has previously reported, research has shown that shorter durations of antibiotics are better for some pediatric infections like acute otitis media (AOM), but this messaging has been slow to reach pediatricians.

“Acute otitis media (AOM) affects approximately 5 million children in the United States annually and accounts for roughly 25% of all antibiotics prescribed to children each year,” Sophie E. Katz, MD, assistant professor of pediatrics and pediatric infectious diseases and associate medical director of the pediatric antimicrobial stewardship program at Vanderbilt University Medical Center, and colleagues wrote.

Katz and colleagues noted that the AAP published guidelines in 2013 that recommend antibiotic durations of 5 to 7 days “for children ages 2 years and older with nonsevere and uncomplicated AOM.”

To assess how providers are prescribing antibiotics for AOM, Katz and colleagues conducted a retrospective analysis that included 73,198 encounters among 54,473 children (median age, 55 months; 48% girls) aged 2 to 17 years that took place from Jan. 1, 2019, through Dec. 31, 2022.

The study used electronic medical record data from 135 care locations within the Vanderbilt University Medical Center and Washington University health systems. The researchers calculated the proportion of encounters where providers prescribed 5-, 7- and 10-day antibiotic courses, prescriptions for antibiotics other than amoxicillin, and cases of treatment failure in which patients returned 3 to 14 days after the initial visit.

Overall, providers prescribed antibiotics during 61,612 (84%) of encounters. Ten-day prescriptions were the most common, accounting for three-quarters of all antibiotic prescriptions. Five percent of encounters resulted in a 5-day antibiotic course.

Seven-day antibiotic prescriptions increased from 2019 to 2022 (11% vs. 26%), and 10-day prescriptions decreased (84% vs. 67%).

Treatment length varied by provider. Most opted for longer treatments, but 5.6% had a mean prescription length of 5 to 7 days.

Treatment failure, recurrence and adverse events were rare.

“It was noteworthy that a small subset of clinicians tended to prescribe shorter durations (mean 5 to 7 days),” Katz and colleagues wrote. “Such clinicians may be particularly useful for antibiotic stewardship programs to engage, both to help champion interventions to promote shorter durations of therapy and to demonstrate the feasibility of changing prescribing behavior.”