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Use of Systemic Antibiotics for Acute Otitis Externa: Impact of a Clinical Practice Guideline

Wang, Xi*; Winterstein, Almut G.*,†; Li, Yan*; Zhu, Yanmin*; Antonelli, Patrick J.

doi: 10.1097/MAO.0000000000001955
RESEARCH METHODOLOGY

Objective: To assess the extent of systemic antibiotic use among patients with acute otitis externa (AOE), as well as the impact of an AOE clinical practice guideline publication in 2006.

Study Design: Interrupted time series study of retrospective data.

Setting: Medicaid billing data from 29 states between 2002 and 2010.

Patients: Patients with age less than 65 years, continuous Medicaid eligibility for 12 months before AOE diagnosis, and dispensation of antibiotics within 1 day before through 3 days after AOE diagnosis.

Main Outcome Measures: The proportion of AOE visits that received systemic antibiotics among all AOE visits that were dispensed any antibiotics, systemic or topical.

Results: We found 682,865 AOE visits that received systemic or topical antibiotics for AOE. The proportion of systemic antibiotic therapy either with or without topical therapy was 43.1% before and 38.3% after AOE guideline publication. There was no significant immediate drop (–0.01; 95%CI, –0.031–0.011) or change in trend (0.002; 95%CI, –0.001–0.004) in the prevalence of systemic antibiotic therapy after guideline publication.

Conclusion: Publication of an AOE clinical guideline did not lead to a decline in systemic antibiotic therapy as initial AOE treatment. Additional efforts will be needed to curb systemic antibiotic treatment for AOE.

*Department of Pharmaceutical Outcomes and Policy, College of Pharmacy

Department of Epidemiology, College of Public Health and Health Professions

Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, Florida

Address correspondence and reprint requests to Patrick J. Antonelli, M.D., Box 100264, Gainesville, FL 32610; E-mail: pa@ufl.edu

Dr. Antonelli has received research support from Alcon Laboratories and Otonomy and remuneration for service on an Otonomy advisory board. Other authors disclose no conflicts of interest.

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