Peer-reviewed article
Improving Guideline-concordant Antibiotic Use for Acute Otitis Media in a Pediatric Primary Care Network.
Sweeney S, Simon A, Morano L, Chang J, Goebel K et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study evaluated a professional education program (Maintenance of Certification project) designed to improve how pediatricians prescribe antibiotics for ear infections in children. The program successfully increased appropriate antibiotic use from 47% to 65% across a network of primary care clinics. Participating clinics showed even greater improvements, reaching 70% appropriate prescribing. Patient outcomes, measured by repeat visits within a week, remained similar before and after the intervention.
Key points
- Guideline-concordant antibiotic use increased from 46.6% at baseline to 64.7% by end of study period
- MOC-participating clinics achieved 70.1% guideline-concordant prescribing versus 54.5% in non-participating clinics
- The intervention included education on using amoxicillin as first-line treatment and shorter (5-7 day) antibiotic courses for children over 2 years with mild-to-moderate symptoms
- Return visits within 7 days for repeat ear infection treatment were similar before (1.0%) and after intervention (1.1%)
- The improvement persisted over the study period from 2021 to 2025
Limitations
The study was conducted in a single ambulatory care network in the United States and may not be generalizable to other healthcare settings or countries. The study does not examine longer-term outcomes beyond 7 days or potential effects on antibiotic resistance patterns.
Abstract
Introduction Maintenance of Certification (MOC) projects have previously been shown to improve diagnostic accuracy and infection treatment in inpatient settings. Methods We developed and delivered an MOC project in our ambulatory care network in 2023 to increase the use of American Academy of Pediatrics guideline-concordant antibiotic selection and duration for the treatment of acute otitis media (AOM), including amoxicillin for most patients, and the use of shorter (5-7 d) antibiotic durations in children over 2 years with nonsevere symptoms. We evaluated the use of guideline-concordant antibiotics across the network from January 2021 to September 2025, including periods before, during, and after the MOC intervention. We compared the use of guideline-concordant antibiotics between clinics that participated in the MOC intervention and those that did not. Results The study period included 40,329 AOM episodes. By the end of the study period, 64.7% of children with AOM across the network received guideline-concordant antibiotic selection and duration, up from 46.6% at baseline. After the intervention, MOC-participating clinics had increased use of guideline-concordant antibiotic selection and duration compared to nonparticipating clinics (70.1% versus 54.5%). The frequency of patients returning within 7 days for a repeat AOM visit did not differ between the baseline period (124/12,735; 1.0%) and the postintervention period (303/27,594; 1.1%) (P = 0.3). Conclusions An MOC program was effective in increasing guideline-concordant antibiotic prescriptions for pediatric AOM across an outpatient network. This effect persisted over time and was stronger in MOC-participating clinics. MOC participation has the potential to improve antibiotic stewardship in ambulatory settings.