Amoxicillin Versus Other Antibiotic Agents for the Treatment of Acute Otitis Media in Children

This retrospective cohort study reaffirms that acute otitis almost always resolves and that amoxicillin is as good or better than other antibiotics for treatment, when treatment is deemed necessary. James W. Mold, MD, MPH

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Objectives: The objective of the study was to compare the antibiotic treatment failure and recurrence rates between antibiotic agents (amoxicillin, amoxicillin-clavulanate, cefdinir, and azithromycin) for children with uncomplicated acute otitis media (AOM).

Study design: We completed a retrospective cohort study of children 6 months-12 years of age with uncomplicated AOM identified in a nationwide claims database. The primary exposure was the antibiotic agent, and the primary outcomes were treatment failure and recurrence. Logistic regression was used to estimate ORs, and analyses were stratified by primary exposure, patient age, and antibiotic duration.

Results: Among the 1 051 007 children included in the analysis, 56.6% were prescribed amoxicillin, 13.5% were prescribed amoxicillin-clavulanate, 20.6% were prescribed cefdinir, and 9.3% were prescribed azithromycin. Most prescriptions (93%) were for 10 days, and 98% were filled within 1 day of the medical encounter. Treatment failure and recurrence occurred in 2.2% (95% CI: 2.1, 2.2) and 3.3% (3.2, 3.3) of children, respectively. Combined failure and recurrence rates were low for all agents including amoxicillin (1.7%; 1.7, 1.8), amoxicillin-clavulanate (11.3%; 11.1, 11.5), cefdinir (10.0%; 9.8, 10.1), and azithromycin (9.8%; 9.6, 10.0).

Conclusions: Despite microbiologic changes in AOM etiology, treatment failure and recurrence were uncommon for all antibiotic agents and were lower for amoxicillin than for other agents. These findings support the continued use of amoxicillin as a first-line agent for AOM when antibiotics are prescribed.

Author/s:

Frost, H. M., Bizune, D., Gerber, J. S., Hersh, A. L., Hicks, L. A., Tsay, S. V.

Cost-effectiveness of management strategies in recurrent acute otitis media

Aubrey Delammermore — Sun, 11 Dec 2022 06:00:00 +0000

Date Added:

December 11, 2022

Journal/Publication:

The Journal of Pediatrics

Publisher:

Elsevier

Publication Date:

December 3, 2022

URL:

Cost-effectiveness of management strategies in recurrent acute otitis media

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jpeds.2022.11.032

Keywords

Recurrent acute otitis media

ear infections

Tympanostomy tube placement

nonsurgical medical management

acute otitis media

PMID (1):

36470464

MeSH

Drug Resistance, Microbial

Treatment Failure

anti-bacterial agents

quality of life

Otitis Media

In children with recurrent acute otitis media, medical management is preferred over tympanostomy tubes from a cost-effectiveness perspective. James W. Mold, MD, MPH

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Objective: To evaluate the cost-effectiveness of tympanostomy tube placement vs. nonsurgical medical management, with the option of tympanostomy tube placement in the event of treatment failure, in children with recurrent acute otitis media (AOM).

Study design: A Markov decision model compared management strategies in children ages 6 to 35 months, using patient-level data from a recently completed, multicenter, randomized clinical trial of tympanostomy tube placement vs. medical management. The model ran over a two-year time horizon using a societal perspective. Probabilities, including risk of AOM symptoms, were derived from prospectively collected patient diaries. Costs and quality-of-life measures were derived from the literature. We performed one-way and probabilistic sensitivity analyses, and secondary analyses in predetermined low- and high-risk subgroups. The primary outcome was incremental cost per quality-adjusted life-year gained.

Results: Tympanostomy tubes cost $989 more per child than medical management. Children managed with tympanostomy tubes gained 0.69 more quality-adjusted life-days than children managed medically, corresponding to $520,855 per quality-adjusted life-year gained. Results were sensitive to the costs of oral antibiotics, missed work, special childcare, the societal cost of antibiotic resistance, and the quality of life associated with AOM. In probabilistic sensitivity analyses, medical management was favored in 66% of model iterations at a willingness-to-pay threshold of $100,000/quality-adjusted life-year. Medical management was preferred in secondary analyses of low- and high-risk subgroups.

Conclusions: For young children with recurrent AOM, the additional cost associated with tympanostomy tube placement outweighs the small improvement in quality of life. Medical management for these children is an economically reasonable strategy.

Keywords: acute otitis media; economic analysis; tympanostomy tubes.

Author/s:

Noorbakhsh, K. A., Liu, H., Kurs-Lasky, M., Smith, K. J., Hoberman, A., Shakh, N.