Trends in otitis media treatment failure and relapse.
OBJECTIVE
The goals were to describe trends in acute otitis media, treatment failure, and relapse and in high-dose amoxicillin use and to determine whether treatment of acute otitis media with high-dose amoxicillin was associated with treatment failure or relapse.


METHODS
We conducted a retrospective study of acute otitis media visits made between 1996 and 2004 by children 2 months to 12 years of age in a large group practice, using computerized data. We defined acute otitis media as an otitis media visit with antibiotics dispensed (preceded by 30 days without otitis media visits), treatment failure as initiation of treatment with a second antibiotic before the first prescription was finished, and relapse as initiation of antibiotic treatment after the first prescription was finished but within 30 days after the index acute otitis media episode. The primary independent measure was high-dose amoxicillin (>70 mg/kg per day). We evaluated changes over time and determined whether high-dose amoxicillin use was associated with otitis media treatment failure or relapse.


RESULTS
We identified 111,335 acute otitis media visits over a 9-year period. The incidence of acute otitis media decreased from 385.1 visits per 1000 enrollees in 1996 to 188.8 visits per 1000 enrollees in 2004. The proportion of acute otitis media visits treated with high-dose amoxicillin increased from 1.7% in 1996 to 41.9% in 2004. Both otitis media treatment failure and relapse rates decreased from 1996 to 2004 (from 3.9% to 2.6% and from 9.2% to 8.9%, respectively). The odds of treatment failure or relapse did not differ between acute otitis media episodes treated with high-dose and low-dose amoxicillin.


CONCLUSIONS
During the past decade, acute otitis media, treatment failure, and relapse became less common and high-dose amoxicillin use increased. However, high-dose amoxicillin treatment did not reduce the risk of individual infections resulting in adverse outcomes.
Sox
Colin M
CM
Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, USA. colin.sox@bmc.org
Finkelstein
Jonathan A
JA
Yin
Ruihua
R
Kleinman
Ken
K
Lieu
Tracy A
TA
D000208:Acute Disease; D017677:Age Distribution; D000658:Amoxicillin / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011336:Probability; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D017211:Treatment Failure; D016896:Treatment Outcome
D000658:Amoxicillin