title: Antimicrobial and analgesic prescribing patterns for acute otitis externa, 2004-2010.
abstract: OBJECTIVE
  Acute otitis externa (AOE) is a common but preventable ear condition. Clinical guidelines issued in 2006 recommended topical treatments for uncomplicated AOE, but systemic antimicrobials appear to be commonly prescribed. The objective of this analysis was to describe pre- and postguideline prescribing patterns by clinician specialty and antimicrobial type and assess trends over time.
  
  
  METHODS
  Retrospective longitudinal analysis of a large insurance database.
  
  
  METHODS
  Outpatient departments in the United States.
  
  
  METHODS
  Initial outpatient visits in 2004 to 2010 for AOE (excluding visits with complicating conditions) were extracted from an insurance database. Prescription drug claims were linked and categorized by clinician specialty and antimicrobial type.
  
  
  RESULTS
  The analysis included 907,261 initial outpatient visits. Use of systemic antimicrobials declined by 4.9% (95% confidence interval [CI], 4.1%, 5.7%) from 36.5% of initial visits in 2004 to 32.1% in 2010. Use of systemic antimicrobials varied by specialty. Systemic antimicrobials were prescribed in 47.1% of 2010 emergency department (ED) visits (-6.9% from 2004, 95% CI -12.3, -1.5), 25.9% of otolaryngologist visits (-1.6%, 95% CI -5.6, 2.4), and 20.4% of pediatrician visits (-6.6%, 95% CI -8.8, -4.4). Penicillins were prescribed most frequently (42.3% of systemic prescriptions in 2010), followed by cephalosporins (19.8%), erythromycin/macrolides (17.4%), and quinolones (11.1%). Opioids were prescribed in 26.4% of ED visits and 9% of outpatient visits.
  
  
  CONCLUSIONS
  Use of systemic antimicrobials declined over time, but one-third of 2010 visits resulted in systemic antimicrobials, despite exclusion of visits with complicating factors. Use of systemic antimicrobials varied by specialty. Further educational efforts and outreach to other specialties might be warranted.
authors.affiliation: Waterborne Disease Prevention Branch, National Center for Enteric and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. scollier@cdc.gov
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Collier
authors.forename: Michele C
authors.initials: MC
authors.lastname: Hlavsa
authors.forename: Emily W
authors.initials: EW
authors.lastname: Piercefield
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beach
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000700:Analgesics / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010032:Otitis Externa / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016012:Poisson Distribution; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000700:Analgesics; D000890:Anti-Infective Agents