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Merck

Race, otitis media, and antibiotic selection.

Pediatrics (2014-11-19)
Katherine E Fleming-Dutra, Daniel J Shapiro, Lauri A Hicks, Jeffrey S Gerber, Adam L Hersh
ABSTRACT

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. 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. 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). 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.

MATERIALS
Product Number
Brand
Product Description

USP
Amoxicillin, United States Pharmacopeia (USP) Reference Standard
Supelco
Amoxicillin trihydrate, VETRANAL®, analytical standard
Supelco
Amoxicillin trihydrate, Pharmaceutical Secondary Standard; Certified Reference Material
Amoxicillin trihydrate, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
Amoxicillin, 95.0-102.0% anhydrous basis
Amoxicillin trihydrate for performance verification, European Pharmacopoeia (EP) Reference Standard