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Oral Antibiotic Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement.
Otolaryngol Head Neck Surg. 2016 05; 154(5):797-803.OH

Abstract

OBJECTIVES

(1) To evaluate the probability of antibiotic administration associated with ICD-9 diagnosis of otitis media with effusion (OME) in the absence of acute otitis media, (2) to determine whether usage varies according to visit setting, and (3) to ascertain if practice gaps are such that future practice changes might be measured.

STUDY DESIGN

Cross-sectional analysis of an administrative database.

SETTING

Ambulatory visits in the United States.

SUBJECTS AND METHODS

National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005-2010; univariate, multivariate, and stratified analyses of antibiotic usage were performed. The study population was restricted to children without acute or unspecified otitis media. The primary outcome was the probability of oral antibiotic administration when OME was diagnosed. The impact of the location of service and subspecialty care was also analyzed.

RESULTS

Data from 1,390,404,196 pediatric visits demonstrated that oral antibiotics were administered for 32% of visits with an OME diagnosis, even in the absence of acute otitis media (odds ratio, 4.31; 95% confidence interval: 2.88-6.44; P < .001). The highest antibiotic administration was seen in the emergency department (risk difference, 37.1%; number needed to harm, 3). No significant increased risk of antibiotic usage was seen during otolaryngology visits. Diagnoses of infections at nonotologic sites were associated with a 1.98 to 26.60 increase in odds of oral antibiotic administration.

CONCLUSION

Oral antibiotics continue to be administered in children with OME in the absence of acute infection, with risk varying by location of service. There is a potential opportunity for quality improvement through reducing antibiotic administration for pediatric OME.

Authors+Show Affiliations

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, University of Calgary, Calgary, Canada.Ear Nose Throat Department, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA.Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA jennifer_shin@meei.harvard.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26932973

Citation

Roditi, Rachel E., et al. "Oral Antibiotic Use for Otitis Media With Effusion: Ongoing Opportunities for Quality Improvement." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 154, no. 5, 2016, pp. 797-803.
Roditi RE, Liu CC, Bellmunt AM, et al. Oral Antibiotic Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngol Head Neck Surg. 2016;154(5):797-803.
Roditi, R. E., Liu, C. C., Bellmunt, A. M., Rosenfeld, R. M., & Shin, J. J. (2016). Oral Antibiotic Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 154(5), 797-803. https://doi.org/10.1177/0194599816633457
Roditi RE, et al. Oral Antibiotic Use for Otitis Media With Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngol Head Neck Surg. 2016;154(5):797-803. PubMed PMID: 26932973.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral Antibiotic Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. AU - Roditi,Rachel E, AU - Liu,C Carrie, AU - Bellmunt,Angela M, AU - Rosenfeld,Richard M, AU - Shin,Jennifer J, Y1 - 2016/03/01/ PY - 2015/10/03/received PY - 2016/01/28/accepted PY - 2016/3/3/entrez PY - 2016/3/5/pubmed PY - 2017/7/18/medline KW - antibiotics KW - otitis media with effusion KW - performance metric KW - practice patterns KW - quality improvement SP - 797 EP - 803 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 154 IS - 5 N2 - OBJECTIVES: (1) To evaluate the probability of antibiotic administration associated with ICD-9 diagnosis of otitis media with effusion (OME) in the absence of acute otitis media, (2) to determine whether usage varies according to visit setting, and (3) to ascertain if practice gaps are such that future practice changes might be measured. STUDY DESIGN: Cross-sectional analysis of an administrative database. SETTING: Ambulatory visits in the United States. SUBJECTS AND METHODS: National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005-2010; univariate, multivariate, and stratified analyses of antibiotic usage were performed. The study population was restricted to children without acute or unspecified otitis media. The primary outcome was the probability of oral antibiotic administration when OME was diagnosed. The impact of the location of service and subspecialty care was also analyzed. RESULTS: Data from 1,390,404,196 pediatric visits demonstrated that oral antibiotics were administered for 32% of visits with an OME diagnosis, even in the absence of acute otitis media (odds ratio, 4.31; 95% confidence interval: 2.88-6.44; P < .001). The highest antibiotic administration was seen in the emergency department (risk difference, 37.1%; number needed to harm, 3). No significant increased risk of antibiotic usage was seen during otolaryngology visits. Diagnoses of infections at nonotologic sites were associated with a 1.98 to 26.60 increase in odds of oral antibiotic administration. CONCLUSION: Oral antibiotics continue to be administered in children with OME in the absence of acute infection, with risk varying by location of service. There is a potential opportunity for quality improvement through reducing antibiotic administration for pediatric OME. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/26932973/Oral_Antibiotic_Use_for_Otitis_Media_with_Effusion:_Ongoing_Opportunities_for_Quality_Improvement_ DB - PRIME DP - Unbound Medicine ER -