Otitis externa-what is the problem with getting it right? A mixed-methods study in primary and secondary care
Mohammed H., Mather MW., Lumb J., Butler CC., Wilson JA.
Introduction: Otitis externa (OE) accounts for 1.1-1.3% of patient presentations in primary care and 25% of urgent referrals to ENT. We aimed to explore: 1) OE clinical decision-making at the primary-secondary care interface; 2) OE prevalence; and 3) Recent trends in antimicrobial resistance in OE-related bacterial isolates and ototopical prescribing. Methods: This is a mixed-methods study drawing on data from primary and secondary care and open NHS sources. Results: 101 GP survey respondents reported frequently prescribing oral antibiotics for OE. GP consultations for OE increased 25% over 15 years. GP ototopical preparations cost the NHS £7,410,440 in 2006; £11,325,241 in 2016. 162 consecutive hospital OE-related bacterial isolates yielded 128 Pseudomonas spp., 18 resistant to gentamicin, 7 to ciprofloxacin. 10 guidelines reviewed showed systematic inconsistencies. Conclusion: GPs reported regularly prescribing oral antibiotics for OE. Antimicrobial drug resistance is common in OE. Available guidance is suboptimal.