Differences in Antibiotic Prescribing Patterns for Children with Acute Otitis Media Based on Patient, Clinician, and Clinic Characteristics.

OBJECTIVES

Children with common infections receive varying care based on their backgrounds; however, data for acute otitis media (AOM) management are limited. Our study aimed to evaluate differences in antibiotic prescribing rate and treatment duration for children (≥2 years) with uncomplicated AOM based on patient, clinician, and clinic characteristics.

METHODS

Retrospective study of health record data from two health systems (123 total sites) from 2019 to 2022. Primary outcomes included: (1) whether an antibiotic was prescribed, and (2) if so, the duration prescribed. Analyses were performed to assess whether differences in prescribing occurred among individual patients, clinicians, or clinics.

RESULTS

Among 66,382 encounters for AOM, children who were races other than White, Hispanic, or had public insurance or self-pay were more likely to be prescribed an antibiotic than children who were White (87% vs. 83%, OR 1.43 [1.12, 1.84]), non-Hispanic (88% vs. 82%, OR 1.54 [1.06, 2.23]), or had commercial/private insurance (87% vs. 83%, OR 1.35 [1.10, 1.67]). The mean treatment duration was ~9 days for all groups, however statistical significance was seen with shorter courses for children who were races other than White, Hispanic, had a primary language other than English, or had public insurance or self-pay. Duration differences were seen among clinicians, with those who prescribed the shortest durations seeing, on average, a greater proportion of children who were races other than White, Hispanic, spoke a non-English primary language, and had public insurance or self-pay.

CONCLUSIONS

Children with AOM who were races other than White, Hispanic, or had public insurance or self-pay were more likely to be prescribed an antibiotic. However, shorter durations were more common among these children, primarily because clinicians serving this population tended to prescribe shorter durations to all patients, regardless of child sociodemographic characteristics.