Journal of the Pediatric Infectious Diseases Society (PIDS)Durations of Antibiotic Treatment for Acute Otitis Media and Variability in Prescribed Durations Across Two Large Academic Health Systems

Persistent Overuse of Long-Duration Antibiotics for Childhood Ear Infections: Implications for Antimicrobial Stewardship

A recent study examining antibiotic prescribing practices for acute otitis media (AOM) in children reveals a significant discrepancy between national guidelines and actual clinical practice. The research, conducted across two large academic health systems, provides insights into the duration of antibiotic treatments prescribed for AOM and highlights potential areas for improvement in pediatric antibiotic stewardship.

Study Design:

• Retrospective analysis of EMR data from 135 care locations across two pediatric academic health systems
• Included outpatient encounters for children aged 2-17 years with AOM diagnosis from 2019-2022
• Primary outcome: Percentage of 5-day antibiotic prescriptions
• Secondary outcomes: Proportions of 7-day and 10-day prescriptions, non-first line antibiotic use, treatment failure rates, AOM recurrence, and adverse drug events

Key Findings:

• 84% of 73,198 AOM encounters resulted in antibiotic prescriptions
• 75% of prescriptions were for 10-day courses
• 20% of prescriptions were for 7-day courses
• Only 5% of prescriptions were for 5-day courses
• Treatment failure, AOM recurrence, adverse drug events, hospitalizations, and follow-up visits within 30 days were rare

HCN Medical Memo
Although current prescribing practices for AOM largely favor longer antibiotic courses, the study’s findings suggest that shorter durations may be equally effective with potentially fewer side effects. Physicians should consider reevaluating their prescribing habits for uncomplicated AOM in children aged 2 and older, aligning more closely with national guidelines recommending 5-7 day courses when appropriate.

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