Table 2.
Prescribing Patterns for Initial Outpatient Visits for Acute Otitis Externa where Systemic Antimicrobials Were Prescribed, by Clinician Specialty, Marketscan Commercial Claims and Encounters Database, United States, 2004–2010
| Percent of Visitsa | ||||||||
|---|---|---|---|---|---|---|---|---|
| Specialty | 2004 (n = 21,948) |
2005 (n = 32,193) |
2006 (n = 31,743) |
2007 (n = 42,182) |
2008 (n = 55,774) |
2009 (n = 61,564) |
2010 (n = 66,137) |
Percentage Changeb |
| All specialties (n = 311,541) | ||||||||
| Penicillin | 45.8 | 45.9 | 44.0 | 42.0 | 42.2 | 41.2 | 42.3 | −3.6 (−4.7, −2.4) |
| Cephalosporin | 23.7 | 22.6 | 23.1 | 22.2 | 20.4 | 20.3 | 19.8 | −4.0 (−4.8, −3.1) |
| Macrolide | 15.2 | 15.8 | 15.4 | 15.9 | 17.0 | 17.0 | 17.4 | 2.2 (1.5, 2.9) |
| Quinolone | 11.2 | 11.3 | 12.0 | 12.6 | 12.2 | 12.1 | 11.1 | −0.1 (−0.6, 0.5) |
| Sulfonamide | 2.3 | 2.9 | 3.7 | 5.0 | 5.9 | 6.7 | 6.8 | 4.6 (4.2, 4.9) |
| Antifungal | 1.5 | 1.3 | 1.4 | 1.7 | 1.7 | 2.0 | 2.0 | 0.5 (0.3, 0.7) |
| Tetracycline | 1.1 | 1.1 | 1.3 | 1.6 | 1.6 | 1.8 | 1.9 | 0.8 (0.6, 1.0) |
| Other | 0.5 | 0.6 | 0.7 | 1.2 | 1.4 | 1.5 | 1.5 | 1.0 (0.8, 1.1) |
| Otolaryngologists (n = 15,278) | ||||||||
| Penicillin | 29.3 | 27.3 | 29.0 | 25.5 | 28.8 | 27.1 | 26.6 | −2.7 (−10.7, 5.2) |
| Cephalosporin | 20.3 | 21.3 | 21.6 | 22.1 | 17.7 | 18.2 | 19.7 | −0.6 (−7.3, 6.0) |
| Macrolide | 9.7 | 10.5 | 8.6 | 8.4 | 9.3 | 9.6 | 9.1 | −0.5 (−5.1, 4.0) |
| Quinolone | 32.2 | 34.6 | 33.6 | 34.6 | 34.0 | 32.6 | 32.2 | 0.0 (−8.4, 8.5) |
| Sulfonamide | 1.7 | 3.0 | 3.2 | 3.9 | 5.3 | 6.0 | 6.0 | 4.4 (1.9, 6.9) |
| Antifungal | 5.4 | 2.9 | 3.4 | 3.9 | 3.9 | 4.5 | 3.7 | −1.7 (−5.0, 1.6) |
| Tetracycline | 2.1 | 1.7 | 1.2 | 1.1 | 1.3 | 1.8 | 1.9 | −0.2 (−2.3, 2.0) |
| Other | 1.6 | 1.1 | 1.8 | 2.5 | 2.0 | 2.4 | 3.3 | 1.7 (−0.4, 3.8) |
| Pediatricians (n = 47,560) | ||||||||
| Penicillin | 61.1 | 60.1 | 59.5 | 55.6 | 53.7 | 53.9 | 53.8 | −7.4 (−14.0, −0.7) |
| Cephalosporin | 23.9 | 24.1 | 25.5 | 28.5 | 28.0 | 27.1 | 27.2 | 3.3 (−1.0, 7.6) |
| Macrolide | 11.7 | 12.4 | 11.0 | 11.4 | 12.2 | 12.8 | 12.2 | 0.5 (−2.5, 3.5) |
| Quinolone | 0.5 | 1.1 | 0.9 | 1.0 | 1.1 | 0.9 | 1.1 | 0.5 (−0.2, 1.3) |
| Sulfonamide | 1.9 | 2.0 | 2.5 | 2.6 | 3.8 | 3.8 | 4.2 | 2.4 (1.0, 3.7) |
| Antifungal | 0.4 | 0.4 | 0.4 | 0.5 | 0.3 | 0.5 | 0.7 | 0.4 (−0.2, 1.0) |
| Tetracycline | 0.7 | 0.4 | 0.3 | 0.3 | 0.5 | 0.6 | 0.6 | −0.1 (−0.8, 0.6) |
| Other | 0.3 | 0.1 | 0.5 | 1.0 | 1.2 | 1.2 | 1.2 | 1.0 (0.3, 1.6) |
| General practitioners (n = 151,982) | ||||||||
| Penicillin | 43.2 | 42.3 | 40.2 | 39.1 | 39.3 | 38.4 | 39.6 | −3.6 (−6.6, −0.5) |
| Cephalosporin | 23.6 | 22.9 | 23.2 | 21.5 | 19.5 | 19.9 | 18.9 | −4.7 (−7.0, −2.5) |
| Macrolide | 16.7 | 17.3 | 17.4 | 18.1 | 19.0 | 19.0 | 19.9 | 3.2 (1.2, 5.1) |
| Quinolone | 12.3 | 12.6 | 13.6 | 14.4 | 13.7 | 13.3 | 12.1 | −0.1 (−1.8, 1.5) |
| Sulfonamide | 2.3 | 2.9 | 3.4 | 4.4 | 5.6 | 6.5 | 6.4 | 4.1 (3.2, 5.0) |
| Antifungal | 1.7 | 1.5 | 1.8 | 1.9 | 2.3 | 2.4 | 2.5 | 0.8 (0.2, 1.5) |
| Tetracycline | 1.3 | 1.3 | 1.6 | 2.0 | 2.0 | 2.2 | 2.3 | 1.0 (0.4, 1.6) |
| Other | 0.4 | 0.4 | 0.5 | 0.8 | 1.0 | 1.0 | 1.0 | 0.6 (0.3, 1.0) |
| Emergency department (n = 33,692) | ||||||||
| Penicillin | 46.7 | 47.0 | 45.6 | 44.9 | 44.1 | 42.8 | 43.1 | −3.6 (−10.6, 3.4) |
| Cephalosporin | 25.3 | 21.8 | 20.7 | 17.5 | 17.4 | 17.5 | 17.4 | −7.8 (−12.8, −2.8) |
| Macrolide | 13.5 | 14.0 | 14.0 | 13.8 | 14.1 | 14.1 | 14.3 | 0.8 (−3.1, 4.6) |
| Quinolone | 10.9 | 12.1 | 12.3 | 12.6 | 12.2 | 12.9 | 11.9 | 1.0 (−2.4, 4.5) |
| Sulfonamide | 3.3 | 4.2 | 6.9 | 10.4 | 10.9 | 11.5 | 12.7 | 9.5 (7.1, 11.9) |
| Antifungal | 0.6 | 0.8 | 0.6 | 0.8 | 0.5 | 0.9 | 0.9 | 0.3 (−0.5, 1.2) |
| Tetracycline | 0.7 | 1.0 | 1.2 | 1.6 | 1.5 | 1.7 | 1.9 | 1.2 (0.2, 2.2) |
| Other | 1.0 | 2.0 | 1.7 | 2.8 | 3.3 | 3.6 | 3.7 | 2.7 (1.4, 4.0) |
| Other specialties (n = 63,029)c | ||||||||
| Penicillin | 44.8 | 46.5 | 43.3 | 41.1 | 42.4 | 41.4 | 43.4 | −1.3 (−6.5, 3.8) |
| Cephalosporin | 24.1 | 21.1 | 22.6 | 21.3 | 19.0 | 18.5 | 17.9 | −6.2 (−9.8, −2.5) |
| Macrolide | 16.3 | 17.2 | 16.9 | 17.1 | 18.9 | 18.9 | 18.8 | 2.5 (−0.7, 5.7) |
| Quinolone | 11.1 | 10.6 | 11.5 | 11.7 | 11.9 | 11.6 | 10.4 | −0.7 (−3.2, 1.9) |
| Sulfonamide | 2.2 | 3.2 | 4.1 | 6.5 | 5.6 | 6.7 | 6.7 | 4.5 (3.1, 5.9) |
| Antifungal | 1.4 | 1.3 | 1.3 | 1.8 | 1.7 | 2.1 | 2.0 | 0.6 (−0.4, 1.5) |
| Tetracycline | 0.9 | 1.1 | 1.2 | 1.6 | 1.6 | 1.9 | 2.1 | 1.2 (0.3, 2.0) |
| Other | 0.6 | 0.6 | 0.7 | 1.5 | 1.4 | 1.5 | 1.3 | 0.7 (0.0, 1.4) |
a
Percentages do not sum to 100 because 2.2% of visits where systemic antimicrobials were prescribed resulted in multiple systemic antimicrobial prescriptions.
b
Percentage change: the difference and 95% confidence interval for percentage of visits resulting in a prescription of the specified systemic antibiotic from 2004 to 2010, calculated using Poisson regression.
c
Other specialties: category includes specialties not classified elsewhere (eg, members of a multispecialty physician group or health care providers at an urgent care facility).