What's New
Announcement
Posted on 08.08.02
Antibiotic Choice and Treatment Outcomes for Acute Otitis Media
By Tamar Ringel-Kulka, MD, MPH, Sue Tolleson-Rinehart, PhD, and Dale
B. Christensen, PhD
Acute otitis media (AOM) is an infection of the middle ear. Anyone can get AOM, but it is most likely to be a problem for very young children, and many children get AOM more than once. Doctors used to think that children who had AOM many times might later have hearing impairment. Some doctors have thought that children who have had many cases of AOM may later be slow to develop their speech. Today, we are not sure the evidence supports that fear.
AOM is one of the most common childhood illnesses. It is the reason for almost 25% of all antibiotics prescribed and prompts 30 million doctor visits each year. Caring for otitis media costs us more than $43 billion dollars annually.
Most clinical practice guidelines today say that antibiotics should be used sparingly for AOM. But if the doctor thinks that an antibiotic should be used, the guidelines say that an older, cheaper drug called amoxicillin still works better than newer, more expensive drugs.
But what kinds of drugs are doctors prescribing? UNC CERTs investigator Dr. Dale Christensen has studied what kinds of antibiotics were prescribed, how much they cost, and how well they worked for children covered by Medicaid in North Carolina.
Dr. Christensen found that doctors were writing prescriptions for the older, cheaper antibiotics such as amoxicillin more than half the time (65%). He found that these antibiotics cost only $12, whereas the cost of the newer drugs is $42.
The older drugs, like amoxicillin, also produced better outcomes. Children who took the older drugs did not have to visit the doctor again for their AOM as often as children taking newer drugs did.
"The older, cheaper drugs give us better treatment outcomes," Dr. Christensen said. "If they work better, and cost less, we should be working hard to get doctors to prescribe the older drugs to children who come in with AOM."
Dr. Christensen and his student, Anu Ayyar-Krishnan, have won an award for their work from the International Society for Pharmaceutical Outcomes Research. Their research shows that following clinical practice guidelines for treating AOM gives sick children better outcomes, at the same time that it saves money.