Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Infectious Diseases, Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado, USA.
J Pediatric Infect Dis Soc. 2024 Sep 26;13(9):455-465. doi: 10.1093/jpids/piae073.
Acute otitis media (AOM) accounts for roughly 25% of antibiotics prescribed to children annually. Despite national guidelines that recommend short (5-7 days) durations of antibiotics for children 2 years and older with AOM, most receive long (10 day) courses. This study aims to evaluate antibiotic durations prescribed for children aged 2-17 years with uncomplicated AOM across two pediatric academic health systems, and to assess the variability in prescribed durations between and within each system.
Electronic medical record data from 135 care locations at two health systems were retrospectively analyzed. Outpatient encounters for children aged 2-17 years with a diagnosis of AOM from 2019 to 2022 were included. The primary outcome was the percent of 5-day prescriptions. Secondary outcomes included the proportion of 7-day prescriptions, 10-day prescriptions, prescriptions for nonfirst-line antibiotics, cases associated with treatment failure, AOM recurrence, and adverse drug events.
Among 73 198 AOM encounters for children 2 years and older, 61 612 (84%) encounters resulted in an antibiotic prescription. Most prescriptions were for 10 days (45 689; 75%), 20% were for 7 days (12 060), and only 5% were for 5 days (3144). Treatment failure, AOM recurrence, adverse drug events, hospitalizations, and office, emergency department or urgent-care visits for AOM within 30 days after the index visit were rare.
Despite national guidelines that recommend shorter durations for children with uncomplicated AOM, 75% of our cohort received 10-day durations. Shortening durations of therapy for AOM could reduce antibiotic exposure and should be a priority of pediatric antibiotic stewardship programs.
急性中耳炎 (AOM) 约占每年儿童开具抗生素处方的 25%。尽管国家指南建议 2 岁及以上患有 AOM 的儿童使用抗生素的疗程为 5-7 天，但大多数儿童接受的疗程为 10 天。本研究旨在评估两个儿科学术医疗系统中 2-17 岁患有单纯性 AOM 的儿童开具的抗生素疗程，并评估每个系统内和系统间的处方疗程差异。
回顾性分析来自两个医疗系统 135 个就诊地点的电子病历数据。纳入 2019 年至 2022 年患有 AOM 的 2-17 岁儿童的门诊就诊记录。主要结局是 5 天疗程处方的比例。次要结局包括 7 天疗程处方的比例、10 天疗程处方的比例、非一线抗生素处方的比例、治疗失败病例、AOM 复发病例和药物不良事件病例。
在 2 岁及以上患有 AOM 的 73198 例儿童中，61612 例（84%）就诊记录开具了抗生素处方。大多数处方为 10 天疗程（45689 例；75%），20%为 7 天疗程（12060 例），仅 5%为 5 天疗程（3144 例）。治疗失败、AOM 复发、药物不良事件、住院以及索引就诊后 30 天内 AOM 的就诊次数（包括门诊、急诊或紧急护理就诊）很少见。
尽管国家指南建议对单纯性 AOM 儿童采用较短疗程，但我们队列的 75%儿童接受了 10 天疗程。缩短 AOM 治疗疗程可以减少抗生素暴露，应成为儿科抗生素管理计划的重点。
