Management of otitis media among children in a large health insurance plan

Background. Otitis media is one of the most common office diagnoses among c hildren in the US and the leading reason for the use of antimicrobials in p ediatric practice. We undertook this study to characterize medical and surg ical management of otitis media. Methods, Using claims data from a large New England health insurer, we iden tified all children <10 years of age who had one or more episodes of acute otitis media between July, 1995, and June, 1996, and examined patterns of t reatment for this condition. Results. Study subjects (n = 22 004) averaged 2.9 physician office visits f or management of otitis media; among children <2 years of age, one-fourth h ad 6 or more such visits. Amoxicillin was prescribed as initial therapy in more than one-half (56.6%) of all episodes of acute otitis media, followed by cephalosporins (18.3%), trimethoprim-sulfamethoxazole (12.3%), macrolide s (6.4%) and amoxicillin-clavulanate (6.0%), Over multiple episodes, howeve r, use of amoxicillin declined by about 50%. Antimicrobial prophylaxis was received by 7.3% of all study subjects for a mean of 61.3 days; the inciden ce of breakthrough episodes of acute otitis media during prophylaxis varied according to the antimicrobial used (13.9, 12.3 and 19.5% for amoxicillin, trimethoprim-sulfamethoxazole and sulfisoxazole, respectively). Surgical p rocedures related to otitis media were performed on 3.8% of all study subje cts, including 4.6% of children <2 years of age. Conclusions. The health care burden of otitis media is large, particularly in the first 2 years of life.