Antibiotic prescribing for otitis media: how well does it match published guidelines?

Otitis media (OM) accounts for approximately 31 million physician visits annually, and is typically treated with antibiotics. Amoxicillin is the recommended first-line treatment; appropriate antibiotic use slows the development of resistance. We analyzed insurance claims from families of employees working at a single company to determine if OM treatments (1) matched published standards; and (2) varied by patient characteristics, type of physician practice or geographic location. Persons diagnosed with OM between 1996 and 1999 were matched to prescription drug claims for those who filled an antibiotic prescription within 3 days of diagnosis. Physicians prescribed amoxicillin for only 31% of acute cases and 19% of recurrent cases. For acute infections in children < or = 2 years the prescribed duration often matched the standard of 10 days, but for persons > 2 years the prescribed duration was often longer than the suggested duration of 5-7 days. For persons of all ages with recurrent infections, the prescribed duration was often shorter than suggested (10 days versus > or = 14 days). There were only modest variations by urban/rural location or provider type.