PHARMACOECONOMICS Don't use expensive antibacterials in paediatric otitis media Use of costly antibacterials is not justified for the treatment of a new episode of acute otitis media in children, as the outcomes do not differ from those seen with low-cost agents such as amoxicillin. This is the finding of a US study supported by the Agency for Health Care Policy and Research. Therefore, changes in prescribing for acute uncomplicated otitis media which reduce the use of expensive antibacterials could reduce costs considerably without compromising outcome. The study involved 12381 children aged ~ 13 years who were enrolled in Colorado's fee-for-service Medicaid programme, and who were treated for a new episode of otitis media in 1991 and 1992. During this time, 581 physicians prescribed antibacterials for otitis media during the index visit, with amoxicillin the most frequently prescribed agent. However, a cephalosporin was prescribed to at least 1 child at an index visit by 55% of the physicians. The rate of prescribing of a second course of antibacterials within 24 days of initial treatment was 11.6% when less costly agents were initially prescribed, compared with 13.2% when more costly agents were initially prescribed.

Amoxicillin the drug of choice For both years, amoxicillin accounted for almost 50% of total antibacterial prescriptions, but for only 9-10% of total antibacterial costs of> $US2 million. All low-cost antibacterials (amoxicillin, cotrimoxazole and erythromycinlsulfafurazole) accounted for 66-67% of total prescriptions, but only 21 % of total costs. In contrast, the more expensive antibacterials (cefaclor, cefixime and amoxicillinl clavulanic acid) accounted for only 30% of prescriptions but 76-77% oftotal costs. The study authors point out that $US399 412 would have been saved in 1992 if 50% of the prescriptions for highcost antibacterials had been written for amoxicillin alone. Interestingly, there were no financial incentives for physicians to choose one antibacterial over another. Berman S, Byrns PJ, Bondy J, Smith PJ, Lezonc D. Otitis media-n:la!ed antibiotic prescribing pancms, outcomes, and expenditures in a pediatric Medicaid population. Pediatrics 100: 585-592, Oct 1997

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Inpharmae 25 Oct 1997 No. 1110

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