BACKGROUND: Otitis media (OM) with effusion (OME) occurs in 90% of children by age 4. Chronic OME may lead to hearing loss; speech, language, and learning difficulties; decreased quality of life; and increased health care utilization. Tympanostomy tube (TT) placement is an established treatment for chronic OME and current standard of practice is to apply topical antibiotics during and after surgery to prevent otorrhea, the most common post-TT complication. Otolaryngology clinical practice guidelines recommend topical antibiotics, not oral, to treat otorrhea at any time in children with TTs. OM is a significant pediatric health burden, associated with over $4B USD in costs.
OBJECTIVE: To characterize resource utilization (antibiotic prescriptions [RX]) in children post-TT placement through Day 30 (D30). Differences between Medicaid-enrolled (MC) and commercially insured (CO) populations were evaluated. METHODS Pediatric patients (less than or equal to 17 years) with TT surgery between 1/1/2010 and 12/31/2013 were included from insurance claims databases. Medical and pharmacy claims within 30 days post-TT surgery were evaluated.
RESULTS: Within 3 days of TT surgery, 23.1% of patients (N=368,847; MC=128,472, CO=240,375) filled a topical RX. From D4 through D30, 10.5% and 14.1% of patients filled a topical and oral RX, respectively; with significant differences between MC and CO cohorts (11.8% and 17.8% vs 9.7% and 12.1%, respectively, p less than 0.0001). 109,005 (29.6%) patients (MC=36,122, CO=72,883) visited the emergency department (ED) or physician office with an ear-related diagnosis (e.g., otorrhea, OM, otalgia); of these, 8.2% and 8.9% had a topical and oral RX, respectively; with significant differences between MC and CO patients (9.7% and 10.9% vs 7.4% and 8.0%, respectively, p less than 0.0001). Following ED visits, 24.6% of patients had a topical and 53.0% an oral RX.
CONCLUSIONS: This study suggests that ~77% of patients may not have received antibiotic prophylaxis after TT surgery, contrary to standard of care. Physicians report giving the bottle of topical antibiotic used during surgery, thus a RX is not filled post-TT. While MC patients are more likely given oral antibiotics than CO, oral antibiotics are inappropriately prescribed and overused in general, indicating that physicians may be unaware of guidelines recommending topical over oral antibiotics for TT otorrhea. Finally, antibiotic use through D30 may indicate failure of topical drop prophylaxis in preventing otorrhea. Payers should consider educational and management strategies to ensure appropriate antibiotic use and evidence-based pediatric care.
