Antibiotic Stewardship in Pediatric Acute Otitis Media

A new study published in the Journal of the Pediatric Infectious Diseases Society has found that most cases of acute otitis media in children aged 2 years and older are treated with 10 days of antibiotics instead of the shorter antibiotic courses as recommended by guidelines.1

The study notes that around one-quarter of antibiotic prescriptions for children annually are for acute otitis media. It aimed to investigate the duration of antibiotics prescribed to children aged 2-17 years with uncomplicated acute otitis media across two pediatric academic health systems, while also examining the inconsistencies in prescription practices both within and across the systems.

The investigators retrospectively reviewed data from electronic medical records at 135 care sites within two health systems - Vanderbilt University Medical Center and Washington University) - between 2019 and 2022. The main focus was on the percentage of 5-day antibiotic prescriptions. Additional outcomes analyzed included the percentages of 7-day and 10-day prescriptions, use of non-first-line antibiotics, instances of treatment failure, recurrence of acute otitis media, and adverse drug events.

Out of 73,198 acute otitis media cases in children aged ≥2 years, 84% (n=61,612) had antibiotic prescriptions. Seventy-five percent (n=45,689) of these prescriptions were for 10-day courses, with 20% (n=12,060) for 7-day courses and only 5% (n=3144) for 5-day courses. The most commonly prescribed antibiotic was amoxicillin (70%); non-first-line antibiotics were prescribed in 30% of cases, cefdinir being the most common (16%). There were “rare” instances of treatment failure, recurrence of AOM, adverse drug events, hospitalizations, and follow-up visits to offices, emergency departments, or urgent care within 30 days of the initial visit. The authors also observed that “if these prescriptions were instead written for 7 days or 5 days, 34 267 or 57 111 antibiotic days per year, respectively, would have been avoided”. 

A five-day antibiotic course has been proven to offer comparable rates of clinical cure and bacterial elimination as the standard 10-day treatment in children aged 2 years and older.

This study demonstrates that despite guidelines recommending shorter antibiotic courses for children with uncomplicated acute otitis media, the majority continue to receive the longer 10-day regimens. Reducing the length of therapy could help minimize antibiotic exposure and reduce antibiotic-associated adverse events, development of treatment-resistant bacteria as well as reducing treatment costs, and should be a key focus of pediatric antibiotic stewardship initiatives.

Reference: J Pediatric Infect Dis Soc. 2024 Sep 26;13(9):455-465. doi: 10.1093/jpids/piae073.