In The News: Order Set Cuts Antibiotic Use for Pediatric Ear Infections in Half

Healio reports on findings shared at IDWeek on antibiotic course length for acute otitis media. According to researchers, creating an order set to automatically select five-day courses for ear infections cut antibiotic use for pediatric ear infections in half. Researchers chose to examine the data after finding providers at their institution were prescribing more days of antibiotics than seemed necessary. The tactic was envisioned as a means of easing clinicians workflow while curbing antibiotic overuse.

In 2013, AAP published guidelines recommending five to seven days of antibiotics in nonsevere cases, 75% of providers at a pair of academic health systems were prescribing 10-day courses for ear infections. To counteract this practice at the researchers’ institution, they created an electronic health record order set preselecting five-day courses for all children over the age of two in emergency departments and urgent care centers within the health system.

Order set implementation began in April 2021 with the study reviewing patient visits from January 2019 to September 2023 to compare antibiotic trends prior to and following intervention. The study included 34,324 patients aged 61 days to 18 years. The proportion of patients who were prescribed antibiotics rose from 88% in 2019 to 93% in 2023 with those receiving the five-day course rising from just 3% to 83%. Overall antibiotic use was cut in half due to the shorter course implementation.

Ear infections were selected for study due to the frequency of occurrence and being the leading reason for antibiotics to be prescribed to children. Prior research has shown three-quarters of children improve without antibiotic intervention and short courses, as recommended in the guidelines, are as safe and effective as longer courses.

PIDS members Joana Dimo and Nicole Poole presented the research and quoted in the story. Dimo said, “One of the great things about our project is that it utilizes the electronic health record ordering system — which is present in every institution — to implement these changes in antibiotic prescribing that we saw, and I think that makes it very reproducible in a wide variety of settings. It is not labor intensive, it is cost effective, and it can result in dramatic changes in antibiotic use.