Abstract
Background: There is a perception among ear, nose, and throat (ENT) surgeons that oral antibiotics are over-prescribed for acute otitis externa (AOE), and the potential for topical therapy as first-line treatment is not fully realized in primary care. We evaluated the prescription rate of topical and oral antibiotics for AOE in primary care and in patients referred to the ENT emergency clinic.Methods: A systematic review was performed by searching the MEDLINE, Embase, PubMed, and Google Scholar databases between January 1990 and October 2020. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool. The outcome measures were the rate of topical and oral antibiotic prescriptions for AOE by primary care practitioners and the rate of oral antibiotic prescriptions that were not indicated.Results: Seven studies met the inclusion criteria. The overall quality of evidence was moderate. The rate of topical antibiotic prescriptions was between 77% and 95%, and oral antibiotics varied between 6% and 30% in patients that were managed only in primary care. Patients that were referred to an ENT emergency clinic had initially been treated by primary care practitioners with topical antibiotics in 14%-60% of cases and oral antibiotics in 16%-17%. The most commonly prescribed oral antibiotics were Amoxicillin and Co-amoxiclav (amoxicillin/clavulanic acid). No study had comprehensively reviewed the indication for oral antibiotics.Conclusion: The rate of topical antibiotic prescriptions for AOE was high in primary care; however, the rate was frequently suboptimal in patients attending the ENT emergency clinic. Although the rate of oral antibiotic prescriptions was relatively low, the choice of antibiotic for empirical treatment frequently did not cover the typical bacteria in AOE. There is a need for improvement in primary care prescribing of topical therapy prior to referral to the ENT emergency clinic.
Highlights
BackgroundAcute otitis externa (AOE) is a common problem for general practitioners (GPs) [1] and is one of the top 10 reasons for antibiotic prescriptions in general practice [2]
Of the remaining 30 articles, review of full texts identified seven studies that were eligible for final analysis, in which 31,650 patients with otitis externa (OE) were assessed
The rate of topical antibiotics prescribed by GPs for patients that were referred to the ENT emergency clinics varied widely from 14% to 50% and up to 60% after an educational intervention for GPs
Summary
Acute otitis externa (AOE) is a common problem for general practitioners (GPs) [1] and is one of the top 10 reasons for antibiotic prescriptions in general practice [2]. It is the condition most frequently referred to the ear, nose, and throat (ENT) emergency clinic [3]. There is a perception among ear, nose, and throat (ENT) surgeons that oral antibiotics are overprescribed for acute otitis externa (AOE), and the potential for topical therapy as first-line treatment is not fully realized in primary care. We evaluated the prescription rate of topical and oral antibiotics for AOE in primary care and in patients referred to the ENT emergency clinic
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