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Otitis externa: what is the problem with getting it right? A mixed-methods study in primary and secondary care.

Authors
  • Mohammed, H1
  • Mather, M W1
  • Lumb, J1
  • Butler, C C2
  • Wilson, J A3
  • 1 Department of ENT, Freeman Hospital, Newcastle upon Tyne, UK.
  • 2 Nuffield Department of Primary Care Health Sciences, Oxford University, UK.
  • 3 Department of Otolaryngology, Population Health Sciences Institute, Newcastle University, UK.
Type
Published Article
Journal
The Journal of Laryngology & Otology
Publisher
Cambridge University Press
Publication Date
Jun 01, 2022
Volume
136
Issue
6
Pages
486–491
Identifiers
DOI: 10.1017/S0022215121003649
PMID: 34819190
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Otitis externa accounts for 1.1-1.3 per cent of patient presentations in primary care and 25 per cent of urgent referrals to ENT. This study aimed to explore otitis externa clinical decision-making at the primary-secondary care interface, otitis externa prevalence and recent trends in antimicrobial resistance in otitis externa related bacterial isolates and ototopical prescribing. This is a mixed-methods study drawing on data from primary and secondary care and open National Health Service sources. A total of 101 general practitioner survey respondents reported frequently prescribing oral antibiotics for otitis externa. General practitioner consultations for otitis externa increased 25 per cent over 15 years. General practitioner ototopical preparations cost the National Health Service £7 410 440 in 2006 and £11 325 241 in 2016. A total of 162 consecutive hospital otitis externa-related bacterial isolates yielded 128 pseudomonas species, with 18 that were resistant to gentamicin and 7 that were resistant to ciprofloxacin. Ten guidelines reviewed showed systematic inconsistencies. General practitioners reported regularly prescribing oral antibiotics for otitis externa. Antimicrobial drug resistance is common in otitis externa. The available guidance is suboptimal.

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