Black children were less likely to be diagnosed with otitis media and more likely to be prescribed narrow-spectrum, rather than broad-spectrum, antibiotics compared with nonblack children, according to a recent study .

“These findings raise concerns that differences in care for otitis media based on race may reflect inappropriate treatment of otitis media with the use of broad-spectrum antibiotics in a majority of U.S. children,” wrote Dr. Katherine E. Fleming-Dutra of Emory University, Atlanta (Pediatrics 2014 [doi:10.1542/peds.2014-1781]).

After a study in the Philadelphia area showed lower otitis media diagnosis rates and less use of broad-spectrum antibiotics for blacks compared with nonblacks, these researchers investigated race, diagnosis, and prescribing patterns nationwide.

They analyzed visits for children 14 years old and younger between 2008 and 2010 using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, both data sets from the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Based on 4,178 visits in the database, the researchers estimated that 19.2 million visits for otitis media occurred from 2008 to 2010 in the United States. However, only 7% of black children’s visits included an otitis media diagnosis, compared with 10% of nonblack children’s visits (P = .004).

While black and nonblack children with otitis media were prescribed antibiotics at similar rates (81% vs. 76%, respectively, P = .30), black children were prescribed broad-spectrum antibiotics 42% of the time, compared with 52% for nonblack children (P = .01). Broad-spectrum cephalosporins were prescribed for otitis media for 12% of black children and 21% of nonblack children; broad-spectrum penicillins were prescribed for 10% of black children and 16% of nonblack children with otitis media.

After adjustment for age, gender, region, insurance, care setting, metropolitan area, and year, black children had 41% lower odds than did nonblack children of receiving a broad-spectrum antibiotic prescription for otitis media.

The study was funded by the CDC. Dr. Gerber and Dr. Hersh received a Pfizer research grant to implement antibiotic stewardship in children’s hospitals. The remaining authors had no relevant financial disclosures.


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