Ll. White et al., ANTIMICROBIALS PRESCRIBED FOR OTITIS-MEDIA IN A PEDIATRIC MEDICAID POPULATION, American journal of health-system pharmacy, 53(24), 1996, pp. 2963-2969
Antimicrobial prescribing patterns for Tennessee Medicaid children hav
ing their first case of otitis media (OM) in at least nine months were
studied. Tennessee Medicaid claims data for patients under 11 years w
hose first documented OM diagnosis in 1993 occurred in the fourth quar
ter and who had had an antimicrobial claim filed within two days of di
agnosis were studied to determine antimicrobial prescribing patterns.
Of 7357 children meeting the study criteria, 70% were less than three
years of age, 65% were Caucasian, and 60% had a rural address. Twenty
antimicrobials were prescribed. Amoxicillin was prescribed most freque
ntly (53% of the time), followed by cefaclor; all first-line therapies
(amoxicillin, ampicillin, erythromycin-sulfisoxazole, and trimethopri
m-sulfamethoxazole) accounted for 64% of the prescriptions, but only o
ne fourth of the costs. The highest use of first-line therapy was asso
ciated with children under three years of age; children without prior
antimicrobial therapy, recent upper respiratory infection (URI), or re
cent sinusitis; children seen by emergency department physicians; and
children seen by urban physicians. Tennessee Medicaid would have saved
$68,250 if first-line therapy had been used for all children having t
heir first occurrence of OM in the fourth quarter alone. The savings t
o the state were estimated at $300,000 or more in 1993 had first-line
therapy been used for most first occurrences of OM in all four quarter
s plus even a small percentage of the estimated 30,000 remaining repea
t OM cases. Amoxicillin was prescribed 53% of the time, and all first-
line therapies 64% of the time, for children with their first case of
OM in at least nine months. In children without recent antimicrobial t
herapy, URI, or sinusitis, first-line therapy was still used only 72%
of the time.