title: Restricted use of antibiotic prophylaxis for recurrent acute otitis media in the era of penicillin non-susceptible Streptococcus pneumoniae.
abstract: OBJECTIVE/INTERVENTION: To compare the annual rates of acute otitis media (AOM) episodes, antibiotic days, and ventilating tube insertion during the first 3 years of life before and after a practice change to restrict use of antibiotic chemoprophylaxis for recurrent AOM.
  The sole pediatric private practice in a rural Kentucky community.
  
  
  METHODS
  Population-based sample of all children born consecutively in two different 13 month intervals. Cohort 1 (n=251) was born before and Cohort 2 (n=274) was born after restricted use of chemoprophylaxis and documented emergence of widespread penicillin non-susceptible Streptococcus pneumoniae (PNSP).
  
  
  METHODS
  Retrospective case cohort comparison.
  
  
  METHODS
  Suppurative AOM diagnosed by validated experienced otoscopists using stringent tympanic membrane criteria.
  
  
  RESULTS
  Children were mostly white with the majority (50-65%) enrolled in daycare during each year. The first episode of AOM was experienced by 6 and 12 months of age in 64 and 86%, respectively. Rates of children with recurrent AOM in Cohorts 1 and 2 were 28 and 31% in Year 1, 17 and 23% in Year 2, and 7 and 10% in Year 3, respectively. Rates of new onset AOM and persistent AOM episodes were similar between cohorts in the first 2 years. Number of days of antibiotic prophylaxis were reduced from 11.2 to 3.4 days in Year 1, from 11.9 to 2.6 days in Year 2, and from 6.9 to 0.7 days in Year 3, respectively (P<0.0001 for each year). Total antibiotic days for Years 1, 2 and 3 were reduced commensurately with prophylactic days from 61.7 to 55.5 days (nonsignificant), from 56.3 to 45.8 days (P=0.047), and from 38.7 to 25.7 days (P<0.0001), respectively. For each year a non-significant trend for increased ventilating tube placement from Cohort 1 to Cohort 2, respectively, was observed, 2 versus 2.2%, 4 versus 5.8%, and 0.8 versus 2.6%. Daycare attendance and white race were consistently significant risk factors for AOM and recurrent AOM.
  
  
  CONCLUSIONS
  In the era of PNSP, restricted use of antibiotic chemoprophylaxis for recurrent AOM was not associated with significantly increased rates of new onset AOM episodes or tube placement in the first 24 months of life. Total antibiotic days were also significantly reduced in Cohort 2 during Years 2 and 3.
authors.affiliation: FAAP, Kentucky Pediatric Research, Inc., 201 South 5th Street, Bardstown, KY 40004, USA. slblock@pol.net
authors.forename: S L
authors.initials: SL
authors.lastname: Block
authors.forename: C J
authors.initials: CJ
authors.lastname: Harrison
authors.forename: J
authors.initials: J
authors.lastname: Hedrick
authors.forename: R
authors.initials: R
authors.lastname: Tyler
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: R
authors.initials: R
authors.lastname: Hedrick
mesh_terms: D000208:Acute Disease; D000704:Analysis of Variance; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007629:Kentucky; D008297:Male; D008876:Middle Ear Ventilation / Q000706:statistics & numerical data; D010035:Otitis Media, Suppurative / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D010403:Penicillin Resistance; D010406:Penicillins / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000502:physiology
chemical_list: D010406:Penicillins