Otitis externa: what is the problem with getting it right? A mixed-methods study in primary and secondary care

Area of Science:

• Otolaryngology
• Infectious Diseases
• General Practice

Background:

• Otitis externa is a common condition in primary care and a frequent reason for ENT referrals.
• Understanding clinical decision-making, prevalence, and antimicrobial resistance is crucial.

Purpose of the Study:

• To explore clinical decision-making for otitis externa at the primary-secondary care interface.
• To investigate otitis externa prevalence and recent trends in antimicrobial resistance.
• To analyze ototopical prescribing patterns.

Main Methods:

• A mixed-methods study utilizing data from primary and secondary care.
• Analysis of National Health Service (NHS) open data sources.
• Survey of general practitioners (GPs) and review of hospital bacterial isolates and clinical guidelines.

Main Results:

• GPs frequently prescribe oral antibiotics for otitis externa, with a 25% increase in consultations over 15 years.
• Costs for GP ototopical preparations rose significantly between 2006 and 2016.
• High rates of antimicrobial resistance were observed in bacterial isolates (e.g., Pseudomonas species), and reviewed guidelines showed inconsistencies.

Conclusions:

• Regular prescription of oral antibiotics for otitis externa by GPs is common.
• Antimicrobial drug resistance is prevalent in otitis externa infections.
• Existing clinical guidance for otitis externa management is suboptimal.