Race, otitis media, and antibiotic selection.

TitleRace, otitis media, and antibiotic selection.
Publication TypeJournal Article
Year of Publication2014
AuthorsFleming-Dutra KE, Shapiro DJ, Hicks LA, Gerber JS, Hersh AL
JournalPediatrics
Volume134
Issue6
Pagination1059-66
Date Published2014 Dec
ISSN1098-4275
KeywordsAdolescent, African Continental Ancestry Group, Amoxicillin, Anti-Bacterial Agents, Child, Child, Preschool, Drug Utilization, European Continental Ancestry Group, Female, Guideline Adherence, Health Surveys, Healthcare Disparities, Humans, Inappropriate Prescribing, Infant, Macrolides, Male, Multivariate Analysis, Otitis Media, Parental Consent, Practice Patterns, Physicians', Primary Health Care, United States
Abstract

BACKGROUND AND OBJECTIVE: Previous research suggests that physicians may be less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for black versus nonblack children. Our objective was to determine whether race is associated with differences in OM diagnosis and antibiotic prescribing nationally.

METHODS: We examined OM visit rates during 2008 to 2010 for children ≤14 years old using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We compared OM visits between black and nonblack children, as percentages of all outpatient visits and visit rates per 1000. We compared antibiotic prescribing by race as the percentage of OM visits receiving narrow-spectrum (eg, amoxicillin) versus broader-spectrum antibiotics. We used multivariable logistic regression to examine whether race was independently associated with antibiotic selection for OM.

RESULTS: The percentage of all visits resulting in OM diagnosis was 30% lower in black children compared with others (7% vs 10%, P = .004). However, OM visits per 1000 population were not different between black and nonblack children (253 vs 321, P = .12). When diagnosed with OM during visits in which antibiotics were prescribed, black children were less likely to receive broad-spectrum antibiotics than nonblack children (42% vs 52%, P = .01). In multivariable analysis, black race was negatively associated with broad-spectrum antibiotic prescribing (adjusted odds ratio 0.59; 95% confidence interval, 0.40-0.86).

CONCLUSIONS: Differences in treatment choice for black children with OM may indicate race-based differences in physician practice patterns and parental preferences for children with OM.

DOI10.1542/peds.2014-1781
Alternate JournalPediatrics
PubMed ID25404720