Acute otitis media in Quebec's children : antibiotic prescribing patterns and outcomes

Acute otitis media ( AOM) is one of the most common indications for antibiotic use in children. We used the Régie de l'assurance maladie du Québec databases to better understand the prescribing patterns of physicians and to assess the effectiveness of different antibiotics in the treatment of AOM. We selected a cohort of 60,513 children aged < 6 years with a first episode of AOM between June 1999 and June 2002. Failure was defined as either a new dispensation of antibiotic or a hospitalization or outpatient visit for complications related to AOM in the following 30 days. The antibiotic most widely used was amoxicillin (42.8%). Failure occurred in 12,693 (21%) children. Overall, azithromycin was the only antibiotic that was less associated with failure when compared to amoxicillin (odds ratio 0.88; 95% confidence interval 0.82, 0.94). In the first 3 days of treatment, a 50% increased risk of failure was seen when macrolides were initially given. However, azithromycin was associated with a 20% decrease in the risk of failure occurring > 14 days after the beginning of treatment. Other risk factors associated with treatment failure were age < 24 months, antibiotics or hospitalization in the preceding month, and otitis-prone conditions. Considering the results of the effectiveness study, the importance of macrolides resistance among pneumococci, and because there is no single factor or combination of factors that predict with certainty which child will develop early or late failure, amoxicillin should remain the first-line drug of choice