Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 1;38(3):e1151-e1158.
doi: 10.1097/PEC.0000000000002525.

Improving Emergency Department Use of Safety-Net Antibiotic Prescriptions for Acute Otitis Media

Alicia Daggett, Donna R Wyly, Tanis Stewart, Patty Phillips, Cassandra Newell, Brian R Lee, Alaina Burns, Nikita Sharma, Nirav Shastri, Jonathan Rodean  1 , Rana E El Feghaly
Affiliations

Improving Emergency Department Use of Safety-Net Antibiotic Prescriptions for Acute Otitis Media

Alicia Daggett et al. Pediatr Emerg Care. .

Abstract

Objectives: Acute otitis media (AOM) is the most common reason for pediatric antibiotic prescriptions. The 2013 American Academy of Pediatrics' AOM guidelines recommend observation for nonsevere AOM. Our aim was to increase the percentage safety-net antibiotic prescription (SNAP) offered to patients 6 months of age or older diagnosed with AOM in 2 pediatric emergency departments (EDs) from a baseline of 0.5% to 15% in 20 months.

Methods: This is a quality improvement study at a quaternary pediatric medical center with 2 locations, both with EDs. A random chart review revealed that 27.5% of patients diagnosed with AOM in the ED would qualify for a SNAP, but only 0.5% were offered it. Quality improvement interventions were designed to improve safety-net antibiotic prescribing. Both EDs conducted multiple interventions, including algorithm development, provider education, and electronic medical record aids. The primary outcome measure was the percentage of patients offered a SNAP for AOM.

Results: A total of 8226 children 6 months of age or older were diagnosed with AOM in our 2 EDs during the 20-month intervention period. The percentage offered a SNAP increased at both EDs. One ED had a single shift in the mean to 7.9%, whereas the other had 2 shifts in the mean, an initial shift to 5.1% and a second to 7.3%. Providers consistently used the algorithm and electronic medical record aids.

Conclusions: Safety-net antibiotic prescriptions in conjunction with parent education was effective in reducing the use of immediate antibiotic prescriptions in children with AOM in 2 pediatric EDs. Offering a SNAP can reduce unnecessary use of antibiotics, which in turn may decrease antibiotic-related adverse events and antibiotic resistance.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors declare no conflict of interest.

References

    1. Hersh AL, Shapiro DJ, Pavia AT, et al. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics . 2011;128:1053–1061.
    1. Poole NM, Shapiro DJ, Fleming-Dutra KE, et al. Antibiotic prescribing for children in United States emergency departments: 2009–2014. Pediatrics . 2019;143:e20181056.
    1. Rosenfeld RM, Kay D. Natural history of untreated otitis media. Laryngoscope . 2003;113:1645–1657.
    1. Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev . 2015;2015:CD000219.
    1. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics . 2013;131:e964–e999.

Substances

LinkOut - more resources