732. Description of Diagnoses and Antibiotic Management of Otitis Media and Otitis Externa in Adults

Abstract

BackgroundOtitis diagnoses include acute otitis media (AOM), otitis media with effusion (OME), and acute otitis externa (AOE). AOM and OME occur primarily in children, whereas AOE occurs with similar frequency in children and adults. Treatment with amoxicillin or close observation without antibiotics is recommended for pediatric AOM, and oral antibiotics are not routinely recommended to treat OME or uncomplicated AOE. Data on otitis diagnoses in adults is limited. This study’s purpose is to characterize the incidence and antibiotic management of otitis diagnoses in adults. Methods. A retrospective cohort of ambulatory veterans who presented at one of six VA Medical Centers during years 2014–2016 with an ICD-9 or -10 code for AOM, OME, and AOE diagnoses was developed. Data extracted included demographics, vital signs, diagnoses, and antibiotic prescriptions. Incident density rates for adult AOM, OME, and AOE were calculated and compared with rates for acute rhinosinusitis. Antibiotic prescribing rates were calculated. Results. Of 4,759 otitis visits identified, the most frequent diagnoses included AOM (38%), OME (25%), and AOE (34%). A single otitis diagnosis was coded in 95.6% of visits and 13.0% had co-diagnosis of another acute respiratory infection (ARI). The incidence density (±95% confidence interval) was 5.4 (5.2, 5.7), 3.6 (3.5, 3.9), and 4.9 (4.7, 5.2) cases per 1,000 patient-years for AOM, OME, and AOE, respectively. For comparison, the incidence density of rhinosinusitis was 16.6 (16.2, 17.0) cases per 1,000 patient-years. Oral antibiotics were prescribed in 48% of visits: AOM (50%), OME (49%), and AOE (47%). Topical antibiotics were prescribed in 32% of AOE visits. The most common oral and otic antibiotics prescribed were amoxicillin/clavulanate (36%), amoxicillin (28%), azithromycin (11%), and hydrocortisone/neomycin/polymyxin (65%), respectively. Conclusion. Otitis diagnoses in adults were common independent of ARI co-diagnoses, but less frequent than rhinosinusitis. Almost half of the patients received an oral antibiotic including those with AOE and OME, indicating a possible focus for antibiotic stewardship programs. Studies to evaluate diagnostic accuracy and treatment of otitis diagnoses in adults are needed.Disclosures All authors: No reported disclosures.