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Utilization of nonguideline concordant antibiotic treatment following acute otitis media in children in the United States
Purpose Acute otitis media (AOM) is a common indication for antibiotics in children. We sought to characterize the frequency of nonguideline concordant antibiotic therapy for AOM in the United States, by agent and duration. Methods Using national administrative claims data (2016–2019), we identified...
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| Published in: | Pharmacoepidemiology and drug safety 2023-02, Vol.32 (2), p.256-265 |
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| container_title | Pharmacoepidemiology and drug safety |
| container_volume | 32 |
| creator | McGrath, Leah J. Frost, Holly M. Newland, Jason G. O'Neil, Caroline A. Sahrmann, John M. Ma, Yinjiao Butler, Anne M. |
| description | Purpose
Acute otitis media (AOM) is a common indication for antibiotics in children. We sought to characterize the frequency of nonguideline concordant antibiotic therapy for AOM in the United States, by agent and duration.
Methods
Using national administrative claims data (2016–2019), we identified children aged 6 months to 17 years with an oral antibiotic dispensed within 3 days of a new diagnosis of suppurative AOM. Use of nonguideline concordant agents and durations, defined based on national treatment guidelines, were summarized by age, race, rurality, region, and insurance type. Subsequent oral antibiotic dispensing within the year after AOM diagnosis was also evaluated. We created sunburst diagrams to visualize longitudinal patterns of within‐person antibiotic utilization for AOM, by agent and duration.
Results
We identified 789 424 eligible commercially‐insured and 502 239 medicaid‐insured children. Among commercially insured children, 35% received nonguideline concordant agents for AOM, including cefdinir (16%), amoxicillin‐clavulanate (12%), and azithromycin (7%). Fewer children age |
| doi_str_mv | 10.1002/pds.5554 |
| format | article |
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Acute otitis media (AOM) is a common indication for antibiotics in children. We sought to characterize the frequency of nonguideline concordant antibiotic therapy for AOM in the United States, by agent and duration.
Methods
Using national administrative claims data (2016–2019), we identified children aged 6 months to 17 years with an oral antibiotic dispensed within 3 days of a new diagnosis of suppurative AOM. Use of nonguideline concordant agents and durations, defined based on national treatment guidelines, were summarized by age, race, rurality, region, and insurance type. Subsequent oral antibiotic dispensing within the year after AOM diagnosis was also evaluated. We created sunburst diagrams to visualize longitudinal patterns of within‐person antibiotic utilization for AOM, by agent and duration.
Results
We identified 789 424 eligible commercially‐insured and 502 239 medicaid‐insured children. Among commercially insured children, 35% received nonguideline concordant agents for AOM, including cefdinir (16%), amoxicillin‐clavulanate (12%), and azithromycin (7%). Fewer children age <2 years received a nonguideline concordant initial agent (27%) compared to age ≥6 years (41%). More children age <2 years received three or more antibiotics over the following year (34% vs. 3% for children age ≥6 years). The most common treatment duration was 10 days for all ages; treatment duration for the initial antibiotic was nonguideline concordant for 95% and 89% of children age 2–5 years and ≥6 years, respectively. Patterns were similar for medicaid‐insured children.
Conclusions
Nonguideline concordant antibiotic use is common when treating AOM in children, including use of broad‐spectrum agents and longer‐than‐recommended antibiotic durations.</description><identifier>ISSN: 1053-8569</identifier><identifier>EISSN: 1099-1557</identifier><identifier>DOI: 10.1002/pds.5554</identifier><identifier>PMID: 36269007</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Inc</publisher><subject>Acute Disease ; administrative data ; Age ; Amoxicillin ; Amoxicillin-Potassium Clavulanate Combination ; Anti-Bacterial Agents - therapeutic use ; antibacterial agents ; Antibiotics ; Azithromycin ; Cefdinir ; Child ; Children ; data visualization ; Diagnosis ; drug utilization ; Ear diseases ; guideline adherence ; Humans ; Infant ; Medicaid ; Otitis Media ; pediatrics ; United States</subject><ispartof>Pharmacoepidemiology and drug safety, 2023-02, Vol.32 (2), p.256-265</ispartof><rights>2022 John Wiley & Sons Ltd.</rights><rights>2023 John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0002-3016-3287 ; 0000-0002-0312-635X ; 0000-0003-1742-2026 ; 0000-0001-6000-0908 ; 0000-0001-7307-6864</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36269007$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McGrath, Leah J.</creatorcontrib><creatorcontrib>Frost, Holly M.</creatorcontrib><creatorcontrib>Newland, Jason G.</creatorcontrib><creatorcontrib>O'Neil, Caroline A.</creatorcontrib><creatorcontrib>Sahrmann, John M.</creatorcontrib><creatorcontrib>Ma, Yinjiao</creatorcontrib><creatorcontrib>Butler, Anne M.</creatorcontrib><title>Utilization of nonguideline concordant antibiotic treatment following acute otitis media in children in the United States</title><title>Pharmacoepidemiology and drug safety</title><addtitle>Pharmacoepidemiol Drug Saf</addtitle><description>Purpose
Acute otitis media (AOM) is a common indication for antibiotics in children. We sought to characterize the frequency of nonguideline concordant antibiotic therapy for AOM in the United States, by agent and duration.
Methods
Using national administrative claims data (2016–2019), we identified children aged 6 months to 17 years with an oral antibiotic dispensed within 3 days of a new diagnosis of suppurative AOM. Use of nonguideline concordant agents and durations, defined based on national treatment guidelines, were summarized by age, race, rurality, region, and insurance type. Subsequent oral antibiotic dispensing within the year after AOM diagnosis was also evaluated. We created sunburst diagrams to visualize longitudinal patterns of within‐person antibiotic utilization for AOM, by agent and duration.
Results
We identified 789 424 eligible commercially‐insured and 502 239 medicaid‐insured children. Among commercially insured children, 35% received nonguideline concordant agents for AOM, including cefdinir (16%), amoxicillin‐clavulanate (12%), and azithromycin (7%). Fewer children age <2 years received a nonguideline concordant initial agent (27%) compared to age ≥6 years (41%). More children age <2 years received three or more antibiotics over the following year (34% vs. 3% for children age ≥6 years). The most common treatment duration was 10 days for all ages; treatment duration for the initial antibiotic was nonguideline concordant for 95% and 89% of children age 2–5 years and ≥6 years, respectively. Patterns were similar for medicaid‐insured children.
Conclusions
Nonguideline concordant antibiotic use is common when treating AOM in children, including use of broad‐spectrum agents and longer‐than‐recommended antibiotic durations.</description><subject>Acute Disease</subject><subject>administrative data</subject><subject>Age</subject><subject>Amoxicillin</subject><subject>Amoxicillin-Potassium Clavulanate Combination</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>antibacterial agents</subject><subject>Antibiotics</subject><subject>Azithromycin</subject><subject>Cefdinir</subject><subject>Child</subject><subject>Children</subject><subject>data visualization</subject><subject>Diagnosis</subject><subject>drug utilization</subject><subject>Ear diseases</subject><subject>guideline adherence</subject><subject>Humans</subject><subject>Infant</subject><subject>Medicaid</subject><subject>Otitis Media</subject><subject>pediatrics</subject><subject>United States</subject><issn>1053-8569</issn><issn>1099-1557</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNpdkctqHTEMhk1paS4t5AmCoZtsJvH4Ol6GtLlAIIX0rAcfjyZR8LFPxx7CydPXQ9IsshAS-j-EpJ-Qo5adtozxs-2QT5VS8hPZb5m1TauU-bzUSjSd0naPHOT8xFjVrPxK9oTm2jJm9sluVTDgiyuYIk0jjSk-zDhAwAjUp-jTNLhYaA1cYyroaZnAlQ3U5phCSM8YH6jzcwFa5YKZbmBARzFS_4hhmCAudXkEuopYYKD3xRXI38iX0YUM39_yIVld_vpzcd3c3l3dXJzfNltujGy4FmpUojNOOAlWGWc173jn10a1bLQWOnDGeiWt15Zrx730HoTwUlnZgjgkJ69zt1P6O0Mu_QazhxBchDTnnhtutOQd4xX98QF9SvMU63aV0p3qDOMLdfxGzet6ar-dcOOmXf__qRVoXoFnDLB711vWL2b11ax-Mav__fN-yeIfSDuHLw</recordid><startdate>202302</startdate><enddate>202302</enddate><creator>McGrath, Leah J.</creator><creator>Frost, Holly M.</creator><creator>Newland, Jason G.</creator><creator>O'Neil, Caroline A.</creator><creator>Sahrmann, John M.</creator><creator>Ma, Yinjiao</creator><creator>Butler, Anne M.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3016-3287</orcidid><orcidid>https://orcid.org/0000-0002-0312-635X</orcidid><orcidid>https://orcid.org/0000-0003-1742-2026</orcidid><orcidid>https://orcid.org/0000-0001-6000-0908</orcidid><orcidid>https://orcid.org/0000-0001-7307-6864</orcidid></search><sort><creationdate>202302</creationdate><title>Utilization of nonguideline concordant antibiotic treatment following acute otitis media in children in the United States</title><author>McGrath, Leah J. ; Frost, Holly M. ; Newland, Jason G. ; O'Neil, Caroline A. ; Sahrmann, John M. ; Ma, Yinjiao ; Butler, Anne M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p2774-2635f5387a3a4e957a962828cb7510f99e8ea79c549c6926a2c4cce33c45941e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute Disease</topic><topic>administrative data</topic><topic>Age</topic><topic>Amoxicillin</topic><topic>Amoxicillin-Potassium Clavulanate Combination</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>antibacterial agents</topic><topic>Antibiotics</topic><topic>Azithromycin</topic><topic>Cefdinir</topic><topic>Child</topic><topic>Children</topic><topic>data visualization</topic><topic>Diagnosis</topic><topic>drug utilization</topic><topic>Ear diseases</topic><topic>guideline adherence</topic><topic>Humans</topic><topic>Infant</topic><topic>Medicaid</topic><topic>Otitis Media</topic><topic>pediatrics</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McGrath, Leah J.</creatorcontrib><creatorcontrib>Frost, Holly M.</creatorcontrib><creatorcontrib>Newland, Jason G.</creatorcontrib><creatorcontrib>O'Neil, Caroline A.</creatorcontrib><creatorcontrib>Sahrmann, John M.</creatorcontrib><creatorcontrib>Ma, Yinjiao</creatorcontrib><creatorcontrib>Butler, Anne M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pharmacoepidemiology and drug safety</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McGrath, Leah J.</au><au>Frost, Holly M.</au><au>Newland, Jason G.</au><au>O'Neil, Caroline A.</au><au>Sahrmann, John M.</au><au>Ma, Yinjiao</au><au>Butler, Anne M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Utilization of nonguideline concordant antibiotic treatment following acute otitis media in children in the United States</atitle><jtitle>Pharmacoepidemiology and drug safety</jtitle><addtitle>Pharmacoepidemiol Drug Saf</addtitle><date>2023-02</date><risdate>2023</risdate><volume>32</volume><issue>2</issue><spage>256</spage><epage>265</epage><pages>256-265</pages><issn>1053-8569</issn><eissn>1099-1557</eissn><abstract>Purpose
Acute otitis media (AOM) is a common indication for antibiotics in children. We sought to characterize the frequency of nonguideline concordant antibiotic therapy for AOM in the United States, by agent and duration.
Methods
Using national administrative claims data (2016–2019), we identified children aged 6 months to 17 years with an oral antibiotic dispensed within 3 days of a new diagnosis of suppurative AOM. Use of nonguideline concordant agents and durations, defined based on national treatment guidelines, were summarized by age, race, rurality, region, and insurance type. Subsequent oral antibiotic dispensing within the year after AOM diagnosis was also evaluated. We created sunburst diagrams to visualize longitudinal patterns of within‐person antibiotic utilization for AOM, by agent and duration.
Results
We identified 789 424 eligible commercially‐insured and 502 239 medicaid‐insured children. Among commercially insured children, 35% received nonguideline concordant agents for AOM, including cefdinir (16%), amoxicillin‐clavulanate (12%), and azithromycin (7%). Fewer children age <2 years received a nonguideline concordant initial agent (27%) compared to age ≥6 years (41%). More children age <2 years received three or more antibiotics over the following year (34% vs. 3% for children age ≥6 years). The most common treatment duration was 10 days for all ages; treatment duration for the initial antibiotic was nonguideline concordant for 95% and 89% of children age 2–5 years and ≥6 years, respectively. Patterns were similar for medicaid‐insured children.
Conclusions
Nonguideline concordant antibiotic use is common when treating AOM in children, including use of broad‐spectrum agents and longer‐than‐recommended antibiotic durations.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Inc</pub><pmid>36269007</pmid><doi>10.1002/pds.5554</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-3016-3287</orcidid><orcidid>https://orcid.org/0000-0002-0312-635X</orcidid><orcidid>https://orcid.org/0000-0003-1742-2026</orcidid><orcidid>https://orcid.org/0000-0001-6000-0908</orcidid><orcidid>https://orcid.org/0000-0001-7307-6864</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1053-8569 |
| ispartof | Pharmacoepidemiology and drug safety, 2023-02, Vol.32 (2), p.256-265 |
| issn | 1053-8569 1099-1557 |
| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Acute Disease administrative data Age Amoxicillin Amoxicillin-Potassium Clavulanate Combination Anti-Bacterial Agents - therapeutic use antibacterial agents Antibiotics Azithromycin Cefdinir Child Children data visualization Diagnosis drug utilization Ear diseases guideline adherence Humans Infant Medicaid Otitis Media pediatrics United States |
| title | Utilization of nonguideline concordant antibiotic treatment following acute otitis media in children in the United States |
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