title: Trends in antibiotic treatment of acute otitis media and treatment failure in children, 2000-2011.
abstract: OBJECTIVE
  Guidelines to treat acute otitis media (AOM) were published in 2004. Initial declines in prescribing were shown, but it's unknown if they were sustained. We examine trends in antibiotic dispensing patterns to treat AOM among a large population of children. We also document trends in antibiotic failure.
  
  
  METHODS
  Children aged 3 months to 12 years with an AOM diagnosis, enrolled in a commercial claims database between January 1, 2000-December 31, 2011 were included. Pharmacy claims within 7 days of diagnosis were searched for antibiotic prescriptions. Antibiotic failure was defined as a dispensing of a different antibiotic class within 2-18 days after the first prescription. We analyzed trends in antibiotic use and failure by class of antibiotic and year.
  
  
  RESULTS
  We identified over 4 million children under 13 years with AOM. The proportion of antibiotic dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of dispensing rebounded to pre-guideline levels. However, levels began decreasing again in 2010 and the antibiotic use rate in 2011 was 57.6%. Cephalosporin prescriptions increased by 41.5% over eleven years. Antibiotic failure decreased slightly, and macrolides had the lowest proportion of failures, while all other classes had failure rates around 10%.
  
  
  CONCLUSIONS
  In recent years, antibiotic dispensing to treat AOM remains high. In addition, the use of broad-spectrum antibiotics is increasing despite having a high rate of treatment failure. Overprescribing of antibiotics and use of non-penicillin therapy for AOM treatment could lead to the development of antibiotic-resistant infections.
authors: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors: Leah J
authors: LJ
authors: McGrath
authors: Sylvia
authors: S
authors: Becker-Dreps
authors: Virginia
authors: V
authors: Pate
authors: M Alan
authors: MA
authors: Brookhart
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents