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December 10, 2014
Black Children Less Likely to Get Broad Spectrum Antibiotics for Otitis Media 

Atlanta—Prescriptions for broad-spectrum antibiotics are more common for white children diagnosed with ear infections compared to those who are black, according to a new study, which also finds that black children generally are less likely to receive diagnoses for acute otitis media.

Despite the racial disparity, according to the study in the journal Pediatrics, black children actually are more likely to receive care that aligns with the recommended guidelines for treating ear infections.

The CDC-funded study, led by researchers from Emory University in Atlanta, offers two possible explanations for disparities in care: overtreatment and overdiagnosis in white children, and undertreatment and underdiagnosis in black children.

“These findings raise the possibility that physicians bring with them to the exam room cultural and racial biases that influence how they make a diagnosis and prescribe antibiotics,” said senior author Adam Hersh, MD, PhD, assistant professor of pediatrics at the University of Utah School of Medicine.

In reaching the results, researchers focused on a sample of 15,694 physician office visits for respiratory infections and 4,178 visits for ear infections made by children age 14 years and younger between the years 2008 to 2010. According to study authors, the samples extrapolate to a national estimate of 23.5 million, and 6.4 million annual visits, respectively.

Results indicate that 30% fewer children of African-American and other black racial backgrounds were diagnosed with ear infections during physician office visits compared to other children. The comparison group was 95% white and 5% other nonblack racial backgrounds.

In addition, once a diagnosis of otitis media was made, black children were 20% less likely to receive a prescription for broad-spectrum antibiotics.

“These findings may indicate racial differences in the diagnosis of otitis media,” said lead author Katherine Fleming-Dutra, MD, pediatric emergency fellow at Emory University and Children’s Healthcare of Atlanta. “Additionally they may reflect inappropriate treatment of otitis media with the use of broad-spectrum antibiotics in a majority of U.S. children.”

Guidelines recommend narrow-spectrum antibiotics as first-line treatment for ear infection, the study notes, so the black children actually are more likely to receive appropriate care, whether intentional or not.

The authors also suggest that the fewer ear infection diagnoses among black children call into question whether otitis media may be overdiagnosed in children of other races.

“Overtreatment and overdiagnosis in white children could result from the possibility that in some circumstances, parents may expect an antibiotic prescription, or physicians may perceive that they do,” Hersh pointed out, noting the issue was not directly addressed in the study. “Physicians may tailor their diagnosis based on these perceptions of patient expectations.”

Other explanations, according to the study, might be differences in how frequently parents of black children seek care for their children with respiratory infections or return for follow-up visits. Racial differences in the reported rate of medication allergies could also influence the choice of antibiotics, the authors note.

The authors found that equal proportions of black children and children of other races made visits to the doctor for respiratory infections, suggesting that lower rates of ear infection diagnoses in black children are not the result of decreased access to care. They were unable, however, to determine whether the visits were first or follow-up visits, and whether patients had allergies, both of which could impact treatment.

Study authors explain that, despite changes in guidelines in recent years to decrease unnecessary antibiotic use, physicians sometimes err on the side of prescribing antibiotics when the diagnosis is uncertain, even though the drugs are ineffective against viral infections.

“The use of antibiotics is the single most important driver of antibiotic resistance. Further, ear infections lead to more antibiotic prescriptions in the United States than any other diagnosis,” added coauthor Lauri Hicks, DO, medical director of the CDC’s Get Smart: Know When Antibiotics Work program. “By increasing our knowledge base about antibiotic prescribing behaviors, we can develop tools and interventions to improve antibiotic prescribing.”



U.S. Pharmacist Social Connect