Ear infections are less likely to be diagnosed and broad-spectrum antibiotics are less likely to be prescribed among black children than white children, a new study has found. But the discrepancy in prescribing fewer broad-spectrum antibiotics means black children actually are more likely to receive care that aligns with the recommended guidelines for treating ear infections.
Two explanations for the observed disparities in care are overtreatment and overdiagnosis in white children, and undertreatment and underdiagnosis in black children. Addressing behaviors that contribute to these findings may cut down on differential care and antibiotic overuse, both significant public health concerns.
Led by researchers at the University of Utah, Emory University, and the Centers for Disease Control and Prevention (CDC), the study appears in Pediatrics
online on Nov. 17, 2014.
"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," says senior author Adam Hersh, M.D., Ph.D., assistant professor of pediatrics at the University of Utah School of Medicine.
Examination of medical records from across the nation shows that when children were brought to the doctor for upper respiratory infections that commonly lead to ear infections, 30 percent fewer black children (African-American and other black racial backgrounds) were diagnosed with ear infections compared to other children (95 percent white, 5 percent of other non-black racial backgrounds). Once diagnosed with an ear infection, black children were 20 percent less likely to receive a prescription for broad-spectrum antibiotics.
The results indicate that, whether intentional or not, black children are more likely to receive care that aligns with current ear infection treatment guidelines, which specifically recommend a prescription of narrow-spectrum antibiotics, rather than broad-spectrum antibiotics, as first-line treatment. What's more, fewer ear infection diagnoses among black children suggest that in some cases, ear infections may be overdiagnosed in other children.
"These findings may indicate racial differences in the diagnosis of otitis media," says first author Katherine Fleming-Dutra, M.D., 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 for treating ear infections have been updated in recent years in an effort to confront antibiotic overuse. Ear infections can be difficult to accurately diagnose, and it can be hard to distinguish bacterial from viral infections. Physicians sometimes err on the side of prescribing antibiotics when the diagnosis is uncertain, even though they are ineffective against viral infections. Over-prescribing antibiotics, and unnecessary use of broad-spectrum antibiotics, can lead to adverse side effects such as severe diarrhea, and development of antibiotic-resistant bacteria.