Ceftriaxone use for acute otitis media: Associated factors in a large U.S. primary care population

Jeannie Y. Chang Pitter, Children's National Pediatricians & Associates - Foggy Bottom/Capitol Hill, 2021 K St NW, Suite 800, Washington, DC, 20006, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: jcpitter@childrensnational.org.
Lydia Zhong, Children's National Hospital, Division of Pediatric Otolaryngology, 111 Michigan Ave NW, Washington, DC, 20010, USA. Electronic address: lzhong@childrensnational.org.
Rana F. Hamdy, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Children's National Hospital, Division of Infectious Diseases, 111 Michigan Ave NW, West Wing 3.5, Suite 100, Washington, DC, 20010, USA. Electronic address: rhamdy2@childrensnational.org.
Diego Preciado, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Children's National Hospital, Division of Pediatric Otolaryngology, 111 Michigan Ave NW, Washington, DC, 20010, USA. Electronic address: dpreciad@childrensnational.org.
Hengameh Behzadpour, Children's National Hospital, Division of Pediatric Otolaryngology, 111 Michigan Ave NW, Washington, DC, 20010, USA. Electronic address: hbehzadpou@childrensnational.org.
Ellen K. Hamburger, Children's National Pediatricians & Associates - Foggy Bottom/Capitol Hill, 2021 K St NW, Suite 800, Washington, DC, 20006, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: ehamburg@childrensnational.org.

Document Type

Journal Article

Publication Date

9-1-2022

Journal

International journal of pediatric otorhinolaryngology

Volume

160

DOI

10.1016/j.ijporl.2022.111211

Keywords

Acute otitis media; Antibiotic resistance; Ceftriaxone; Otitis-conjunctivitis

Abstract

BACKGROUND: Clinicians in the authors' primary care academic practice have anecdotally perceived an increased use of intramuscular (IM) ceftriaxone, particularly for otitis-conjunctivitis in recent years (pre-pandemic). Increasing rates of ceftriaxone administration for acute otitis media (AOM) may be an important marker of antimicrobial resistance. OBJECTIVE: We aimed to characterize the population of patients who received ceftriaxone for treatment of AOM, testing our hypothesis that patients with concomitant conjunctivitis would have increased rates of ceftriaxone receipt. DESIGN/METHODS: We reviewed cases of AOM at a large U.S. primary care practice from August 2017 to July 2019. We determined the association between each of the following variables and ceftriaxone injection using multivariate analysis: age at AOM diagnosis, provider type, insurance (public vs private), season of year, and presence of conjunctivitis. RESULTS: There were 6028 AOM episodes in 5195 patients resulting in a total of 7688 patient encounters. Of these episodes, 642 (10.7%) had a concurrent diagnosis of conjunctivitis; 362 (6.0%) ultimately received ceftriaxone. Conjunctivitis was the strongest predictor of treatment with ceftriaxone. The proportion of episodes with conjunctivitis treated with ceftriaxone was 14.5% (93/642) versus 5.0% (269/5386) without conjunctivitis (p < 0.0001). Patients who received ceftriaxone were younger; mean age (SD) for patients receiving ceftriaxone was 14.0 (8.8) months versus 25.0 (23.4) months (p < 0.0001). CONCLUSION(S): There is a strong correlation between the presence of conjunctivitis and receipt of IM ceftriaxone in this large U.S. academic primary care clinic. Younger age was also associated with ceftriaxone treatment. Further study on emerging resistance patterns and implications for management of AOM in young children is warranted.

Department

Pediatrics

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