Antimicrobial and analgesic prescribing patterns for acute otitis externa, 2004-2010

Area of Science:

• Infectious Diseases
• Otolaryngology
• Pharmacology

Background:

• Acute otitis externa (AOE) is a prevalent and preventable ear infection.
• Clinical guidelines from 2006 advocate topical treatments for uncomplicated AOE.
• Systemic antimicrobial prescribing for AOE has been observed despite guideline recommendations.

Purpose of the Study:

• To analyze prescribing patterns for systemic antimicrobials in AOE before and after 2006 guidelines.
• To examine trends in antimicrobial type and clinician specialty prescribing.
• To assess changes in AOE treatment over time.

Main Methods:

• Retrospective longitudinal analysis of a large US insurance database (2004-2010).
• Extracted initial outpatient visits for uncomplicated AOE.
• Linked prescription claims to categorize antimicrobial type and clinician specialty.

Main Results:

• Systemic antimicrobial use decreased from 36.5% (2004) to 32.1% (2010).
• Prescribing varied significantly by specialty: 47.1% in EDs, 25.9% in otolaryngology, 20.4% in pediatrics in 2010.
• Penicillins were the most frequent systemic antimicrobial prescribed.

Conclusions:

• Despite a decline, systemic antimicrobials were prescribed in one-third of AOE visits in 2010.
• Significant inter-specialty variation in prescribing suggests inconsistent guideline adherence.
• Targeted educational initiatives for clinicians may be necessary to promote guideline-concordant topical therapy.