Investigators from multiple institutions conducted a retrospective study to compare treatment failures and infection recurrences in children with uncomplicated acute otitis media (AOM) treated with different antibiotics. For the study, they reviewed data in the IBM MarketScan Commercial Database which includes linked medical and prescription claims data on individuals ≤65 years old with private health insurance from 24 health plans in the US. Study participants were children 6 months to 12 years old with a ICD-10 diagnostic code for AOM in 2018. Only AOM encounters that were associated with a prescription for amoxicillin, amoxicillin-clavulanate, cefdinir, or azithromycin were included in the analyses. Antibiotic courses were classified as short (5-9 days) or long (10-12 days). Data on provider type (eg, pediatrician), and clinical setting were abstracted. The primary outcomes were treatment failure, defined as a new prescription for the same antibiotic or for a different antibiotic 2-14 days after the index encounter, and infection recurrence, defined as an antibiotic prescription 15-30 days after the encounter. Logistic regression was used to compare these outcomes among children treated for AOM with different antibiotics and after long or short antibiotic courses, after adjusting for age, sex, region of the country, and clinical setting.
Data were included on 1,051,007 AOM encounters. Overall, 53.1% of antibiotic prescriptions were by pediatricians, and 87.9% of visits occurred in an office setting; 61.5% of children were 6 months to 5 years old. Amoxicillin was prescribed for 56.6% of cases of AOM, followed by cefdinir (20.6%), amoxicillin-clavulanate (13.5%), and azithromycin (9.3%). Treatment failures occurred after 2.2% of index AOM encounters and infection recurrences after 3.3% of encounters. Compared to treatment with amoxicillin, treatment failures were significantly more common among patients treated with cefdinir (adjusted odds ratio [aOR], 9.66; 95% CI, 9.22, 10.12), amoxicillin-clavulanate (aOR, 11.36; 95% CI, 10.82, 11.93), and azithromycin (aOR, 11.79; 95% CI, 11.19, 12.43). Similarly, recurrences were significantly more common following treatment with the other antibiotics than with amoxicillin, with aORs ranging from 4.36 for azithromycin to 4.96 for amoxicillin-clavulanate. Treatment failures were more common after short courses of antibiotics compared to long (2.3% and 1.9%, respectively; aOR, 1.43; 95% CI, 1.35, 1.51), but recurrences were less frequent with short antibiotic courses (2.1% after short courses and 3.2% after long courses; aOR, 0.78; 95% CI, 0.73, 0.82).
The authors conclude treatment failures and recurrences in children with uncomplicated AOM were uncommon with all assessed antibiotics, and lower for amoxicillin than the other agents.
Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
The results of this study supports the use of amoxicillin as a first-line therapy of AOM in children when a decision to treat with...