Study suggests shorter duration of first line antibiotics for simple acute otitis media in children: Study

A new study by Sophie Katz and team suggests short term duration of first line antibiotics for children with simple acute otitis media (AOM). The findings of this study were published in Journal of the Pediatric Infectious Diseases Society. About 25% of children's antibiotic prescriptions are for acute otitis media. Majority of the children with AOM who were over two years of age receive lengthy (10-day) regimens of antibiotics, even though national recommendations suggest shorter (5 to 7 days) treatments. Thus, this study was set out to compare the length of time antibiotics were given for children with uncomplicated AOM who were between the ages of 2 and 17 in two pediatric academic health systems, as well as to determine how long the prescriptions varied within each system.

This retrospective analysis was done on electronic medical record (EMR) data from 135 care sites across two health systems. The study encompassed outpatient interactions from 2019 to 2022 for children with an AOM. The percentage of 5-day prescriptions was the main result. The percentage of 7-day and 10-day prescriptions, instances linked to treatment failure, prescriptions for antibiotics other than first-line therapy, recurrence of AOM and adverse medication events were among the secondary outcomes.

A total of 61,612 (84%) of the 73,198 AOM visits involved children of 2 years and over ended in an antibiotic prescription. Only 5% of prescriptions (3,144) were for five days when compared to the majority (45,689; 75%) which were for seven days. It was uncommon for patients to experience treatment failure, recurrence of AOM, adverse medication events, hospital stays, and office, ER, or emergency room visits for AOM within 30 days following the index visit.

Overall, 75% of antibiotic prescriptions were given longer than necessary. There was little variation in the use of 5-day durations among individual practitioners and it was unusual to find them across all types of care sites. Reducing the length of therapy for AOM has the potential to significantly lower the exposure to antibiotics in children and this might have a significant impact on reducing the emergence of adverse events, antibiotic resistance, and other unintended effects of antibiotic use. Therefore, there is an urgent need for outpatient pediatric antibiotic stewardship to scale up initiatives to encourage the more general use of short treatment durations and first line antibiotics.

Reference:

Katz, S. E., Jenkins, T. C., Stein, A. B., Thomas, G., Koenig, N., Starnes, G. L., Newland, J. G., Banerjee, R., & Frost, H. M. (2024). urations of antibiotic treatment for acute otitis media and variability in prescribed durations across two large academic health systems. In Journal of the Pediatric Infectious Diseases Society. Oxford University Press (OUP). https://doi.org/10.1093/jpids/piae073