Surveys show racial differences in OM diagnosis, treatment

SAN FRANCISCO – Black children were less likely than nonblack children to receive an otitis media diagnosis and, when treated for otitis media, were less likely to receive a broad-spectrum antibiotic, national survey data showed.

Overall, there were no significant differences in the rate of outpatient visits for respiratory illness and otitis media (OM) between black children and nonblack children aged 0-14 years who participated in the National Ambulatory Care Survey and the National Hospital Ambulatory Medical Care Survey during 2008-2010 (1,175 vs. 1,150 per 1,000 population for respiratory visits; 253 vs. 324 per 1,000 population for OM visits), but the percentage of all visits resulting in an OM diagnosis was significantly lower among black children (7% vs. 10%), Dr. Katherine E. Fleming-Dutra of Emory University and the Centers for Disease Control and Prevention, Atlanta, reported in a poster at an annual scientific meeting on infectious diseases.

Furthermore, while the percentage of OM visits leading to an antibiotic prescription did not differ significantly between black and nonblack children, (81% vs. 76%), among those who did receive antibiotics, black children were significantly less likely than nonblack children to receive broad-spectrum antibiotics (42% vs. 52%), Dr. Fleming-Dutra reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

After adjustment for potential confounders, black race remained a significant protective factor against prescription of a broad-spectrum antibiotic (adjusted odds ratio, 0.59), she noted.

The findings support those from a prior regional study that also showed a lower rate of OM diagnosis and lower broad-spectrum antibiotic use in black children, and suggest these racial differences in diagnosis and prescribing also occur at the national level, Dr. Fleming-Dutra said, noting that race-based differences in physician and parental preferences may contribute to inappropriate antibiotic prescribing for nonblack children.

"Reducing antibiotic prescriptions and broad-spectrum antibiotic prescribing is a major public health goal. ... National guidelines recommend that not all patients with OM require antibiotics, and when they do, amoxicillin is recommended for most children with OM," she said.

Providers may be tailoring the diagnosis to justify an antibiotic prescription in nonblack children, she added.

"Provider education campaigns should target appropriate communication with parents regarding the need for and use of antibiotics, and how to determine and manage parental expectations," she concluded.

Dr. Fleming-Dutra reported having no relevant financial conflicts.

SAN FRANCISCO – Black children were less likely than nonblack children to receive an otitis media diagnosis and, when treated for otitis media, were less likely to receive a broad-spectrum antibiotic, national survey data showed.

Overall, there were no significant differences in the rate of outpatient visits for respiratory illness and otitis media (OM) between black children and nonblack children aged 0-14 years who participated in the National Ambulatory Care Survey and the National Hospital Ambulatory Medical Care Survey during 2008-2010 (1,175 vs. 1,150 per 1,000 population for respiratory visits; 253 vs. 324 per 1,000 population for OM visits), but the percentage of all visits resulting in an OM diagnosis was significantly lower among black children (7% vs. 10%), Dr. Katherine E. Fleming-Dutra of Emory University and the Centers for Disease Control and Prevention, Atlanta, reported in a poster at an annual scientific meeting on infectious diseases.

Furthermore, while the percentage of OM visits leading to an antibiotic prescription did not differ significantly between black and nonblack children, (81% vs. 76%), among those who did receive antibiotics, black children were significantly less likely than nonblack children to receive broad-spectrum antibiotics (42% vs. 52%), Dr. Fleming-Dutra reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

After adjustment for potential confounders, black race remained a significant protective factor against prescription of a broad-spectrum antibiotic (adjusted odds ratio, 0.59), she noted.

The findings support those from a prior regional study that also showed a lower rate of OM diagnosis and lower broad-spectrum antibiotic use in black children, and suggest these racial differences in diagnosis and prescribing also occur at the national level, Dr. Fleming-Dutra said, noting that race-based differences in physician and parental preferences may contribute to inappropriate antibiotic prescribing for nonblack children.

"Reducing antibiotic prescriptions and broad-spectrum antibiotic prescribing is a major public health goal. ... National guidelines recommend that not all patients with OM require antibiotics, and when they do, amoxicillin is recommended for most children with OM," she said.

Providers may be tailoring the diagnosis to justify an antibiotic prescription in nonblack children, she added.

"Provider education campaigns should target appropriate communication with parents regarding the need for and use of antibiotics, and how to determine and manage parental expectations," she concluded.

Dr. Fleming-Dutra reported having no relevant financial conflicts.

SAN FRANCISCO – Black children were less likely than nonblack children to receive an otitis media diagnosis and, when treated for otitis media, were less likely to receive a broad-spectrum antibiotic, national survey data showed.

Overall, there were no significant differences in the rate of outpatient visits for respiratory illness and otitis media (OM) between black children and nonblack children aged 0-14 years who participated in the National Ambulatory Care Survey and the National Hospital Ambulatory Medical Care Survey during 2008-2010 (1,175 vs. 1,150 per 1,000 population for respiratory visits; 253 vs. 324 per 1,000 population for OM visits), but the percentage of all visits resulting in an OM diagnosis was significantly lower among black children (7% vs. 10%), Dr. Katherine E. Fleming-Dutra of Emory University and the Centers for Disease Control and Prevention, Atlanta, reported in a poster at an annual scientific meeting on infectious diseases.

Furthermore, while the percentage of OM visits leading to an antibiotic prescription did not differ significantly between black and nonblack children, (81% vs. 76%), among those who did receive antibiotics, black children were significantly less likely than nonblack children to receive broad-spectrum antibiotics (42% vs. 52%), Dr. Fleming-Dutra reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

After adjustment for potential confounders, black race remained a significant protective factor against prescription of a broad-spectrum antibiotic (adjusted odds ratio, 0.59), she noted.

The findings support those from a prior regional study that also showed a lower rate of OM diagnosis and lower broad-spectrum antibiotic use in black children, and suggest these racial differences in diagnosis and prescribing also occur at the national level, Dr. Fleming-Dutra said, noting that race-based differences in physician and parental preferences may contribute to inappropriate antibiotic prescribing for nonblack children.

"Reducing antibiotic prescriptions and broad-spectrum antibiotic prescribing is a major public health goal. ... National guidelines recommend that not all patients with OM require antibiotics, and when they do, amoxicillin is recommended for most children with OM," she said.

Providers may be tailoring the diagnosis to justify an antibiotic prescription in nonblack children, she added.

"Provider education campaigns should target appropriate communication with parents regarding the need for and use of antibiotics, and how to determine and manage parental expectations," she concluded.

Dr. Fleming-Dutra reported having no relevant financial conflicts.