282. Adherence to Acute Otitis Media guidelines in Pediatricians’ Offices, Urgent Care Centers, and a Pediatric Emergency Department
Session: Poster Abstract Session: Pediatric Antimicrobial and Diagnostic Stewardship
Thursday, October 4, 2018
Room: S Poster Hall
  • OM_ID2018_Islam-ABH.pdf (116.8 kB)
  • Background:

    Acute otitis media (AOM) is a common diagnosis in outpatient pediatrics that often results in antibiotic prescriptions. In 2013, revised clinical practice guidelines for AOM by the American Academy of Pediatrics (AAP) recommended reserving antibiotics and a watchful waiting (WW) approach in most scenarios; amoxicillin +/-clavulanate as 1st-line agents if treating; and courses of >7 days to be clearly indicated only in severe cases in those ≤2 years old. Adherence to AOM guidelines amongst pediatric providers, especially in non-academic outpatient settings, has not been well characterized.


    In a large community-based sepsis point prevalence study, diagnosis, antibiotic prescription, and other data were collected from all patients aged 0 to 18 years seen on 9/5/16, 12/5/16, 3/6/2017, and 6/5/17, in the Emergency Department (ED) of the Women and Children’s Hospital of Buffalo, 11 primary pediatric (PMD) offices, and 2 private urgent care centers (UCC) in Buffalo, NY. For this secondary analysis, all children with a provider diagnosis of acute otitis media (AOM) were identified. Adherence to AAP AOM guidelines were analyzed and compared relative to clinical care setting.


    Of 2062 sick visits, 6% (121) were diagnosed with AOM, and in 82% of these antibiotics were prescribed: 91% (39/43) in ED; 70% (21/30) in UCC; 83% (40/48) in PMD, p=0.071. When prescribed, 69% of antibiotics were 1st-line agents. In UCC and PMD, oral 3rd generation cephalosporins were the most common non-1st line agents, followed by azithromycin (20% and 8% of all antibiotic prescribed cases respectively). 90% of antibiotic courses were ≥ 7 days. There were no differences in prescribing practices between outpatient settings


    A recent study found that WW is clinically appropriate in >50% of pediatric AOM and overall cost-effective. However, in our analysis, antibiotics are still being prescribed in 4 out of 5 cases. Non-1st line agents, which are excessively broad and/or suboptimal in targeting the main pathogens for pediatric AOM, are given in over a quarter of prescriptions. Increasing awareness and adherence to AOM guidelines, in various outpatient settings, should be a major target of pediatric antibiotic stewardship efforts.

    Shamim Islam, MD, DTM&H, University at Buffalo, State University of New York, Buffalo, NY and Amanda Hassinger, MD, MS, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY


    S. Islam, None

    A. Hassinger, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.