Diagnosis and Antibiotic Management of Otitis Media and Otitis Externa in United States Veterans

Abstract

Background Acute otitis media (AOM) and otitis media with effusion (OME) occur primarily in children, whereas acute otitis externa (AOE) occurs with similar frequency in children and adults. Data on the incidence and management of otitis in adults are limited. This study characterizes the incidence, antibiotic management, and outcomes for adults with otitis diagnoses. Methods A retrospective cohort of ambulatory adult veterans who presented with acute respiratory tract infection (ARI) diagnoses at 6 VA Medical Centers during 2014–2018 was created. Then, a subcohort of patients with acute otitis diagnoses was developed. Patient visits were categorized with administrative diagnostic codes for ARI (eg, sinusitis, pharyngitis) and otitis (OME, AOM, and AOE). Incidence rates for each diagnosis were calculated. Proportions of otitis visits with antibiotic prescribing, complications, and specialty referral were summarized. Results Of 46 634 ARI visits, 3898 (8%) included an otitis diagnosis: OME (22%), AOM (44%), AOE (31%), and multiple otitis diagnoses (3%). Incidence rates were otitis media 4.0 (95% confidence interval [CI], 3.9–4.2) and AOE 2.0 (95% CI, 1.9–2.1) diagnoses per 1000 patient-years. By comparison, the incidence rates for pharyngitis (8.4; 95% CI, 8.2–8.6) and sinusitis (15.2; 95% CI, 14.9–15.5) were higher. Systemic antibiotics were prescribed in 75%, 63%, and 21% of AOM, OME, and AOE visits, respectively. Complications for otitis visits were low irrespective of antibiotic treatment. Conclusions Administrative data indicated that otitis media diagnoses in adults were half as common as acute pharyngitis, and the majority received antibiotic treatment, which may be inappropriate. Prospective studies verifying diagnostic accuracy and antibiotic appropriateness are warranted.

Comparative effectiveness of amoxicillin versus amoxicillin‐clavulanate among adults with acute sinusitis in emergency department and urgent care settings

“…Potential infectious complications (ie, Clostridioides difficile infections, pneumonia, meningitis, mastoiditis, or facial cellulitis) were identified by a new outpatient or inpatient diagnostic code for these conditions within 30 days following the index visit (eTable S7). [9][10][11] Return visits for gastrointestinal-related adverse antibiotic events were identified by outpatient visits or inpatient admissions with diagnostic codes consistent with potential gastrointestinal-related adverse antibiotic events (ie, diarrhea, colitis, hepatitis, nausea) for visits that occurred within 14 days after the index acute sinusitis visit if the patient did not have a similar diagnostic code within 6 months preceding the visit (eTable S7). 10 Hospitalizations were defined by an admission date that occurred between 1 and 30 days following the index visit.…”

Patients Requiring Gastrostomy Tube Insertion After Total Laryngectomy Have a Higher Incidence of Otitis Media

“…In 2005, the World Health Organization reported that, globally, 51% of otitis media cases occurred in patients aged <5 years, and the global incidence rate was between 1.49 and 3.14 cases per 100 people-years for people aged ≥20. Given that otitis media in the general adult population is rare, the otitis media prevalence appears to increase after total laryngectomy [ 11 , 12 ]. In this study, gastrostomy tube insertion was significantly associated with otitis media, and 80% (4 of 5) of patients who underwent postoperative gastrostomy tube insertion developed otitis media.…”

Diagnosis and Management of Acute Otitis Media

“…Kemudian, pengobatan lini kedua dapat diberikan amoksisilin dengan asam klavuanat. Pengobatan lini kedua diindikasikan untuk kondisikondisi tertentu seperti konjungtivitis, pasien yang mengonsumi amoksisilin dalam 30 hari terakhir, dan riwayat otitis media berulang yang tidak responsif oleh amoksisilin (Pontefract et al, 2019).…”

“…Pada anak-anak dengan otitis media yang tidak berat direkomendasikan antibiotik sesuai usia atau mengamati resolusi gejala dalam waktu 48-72 jam sebelum meresepkan antibiotik (Pontefract et al, 2019). Antibiotik lini pertama yang dapat diberikan, yaitu amoksisilin 50 sampai 60 mg/kgBB/hari yang terbagi dalam 2-3 dosis untuk pasien tanpa alergi terhadap penicillin.…”