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

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.