PEE5: INAPPROPRIATE ANTIBIOTIC PRESCRIBING AND ECONOMIC OUTCOMES FOR PEDIATRIC OTITIS MEDIA

Abstract

OBJECTIVES: To examine physician prescribing pattern of antibiotics for otitis media in children and compare them with therapeutic guidelines issued by the American Academy of Pediatrics, Family Physicians, and Otolaryngology, for appropriateness. Also, to calculate the cost savings that could be achieved by adhering to the guidelines. METHODS: Data from the National Ambulatory Medical Care Survey (NAMCS) 1997 was utilized. Patients with principal diagnosis of otitis media with age less than or equal to 12 years were analyzed using multiple linear and binomial logit regression models. Appropriate antibiotics are defined as those that are recommended by the guidelines. The average wholesale price of recommended antibiotics was compared with the inappropriate antibiotics prescribed. The dosage of antibiotics was confirmed by the IMS health and the advice of a practicing Otolaryngologist. Antibiotics cost was calculated by using the Red Book 1997 and 1998. The weighted average method was used to calculate the average wholesale price of the various quantity packages and dosage forms. This study utilized the methodology of relating a secondary database to an outside source (Red Book) to calculate the cost. RESULTS: The average cost of a course of appropriate antibiotic (penicillin and its derivatives) was found to be $8.07, compared to $69.56 for expensive antibiotics (difference = $61.49). Children less than four years of age were prescribed more expensive antibiotics (R2 = 0.287). Pediatricians, and Otolaryngologists prescribed appropriate and less expensive antibiotics than other family physicians (R2 = 0.144). There was no relationship between the physician's specialty and patient's age for inappropriate antibiotics prescribing (R2 = 0.345). CONCLUSIONS: Adhering to the guidelines and prescribing of appropriate antibiotics appears to save cost. Inappropriate prescribing of antibiotics for otitis media should be addressed more explicitly in general practice.