Appropriateness of Otic Quinolone Use among Privately Insured US Patients. (19th November 2019)

• Record Type: Journal Article
• Authors: Tran, Phuong T.; Winterstein, Almut G.; Wang, Xi; Rhew, Kiyon; Antonelli, Patrick J.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 162:Number 1(2020)
• Page Start: 102
• Page End: 107
• Publication Date: 2019-11-19
• Subjects: otic quinolone -- off‐label -- utilization -- overprescribing; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599819889607
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objective: Considering emerging safety concerns involving otic quinolones, we assessed the extent of otic quinolone use for questionable indications. Study Design: Descriptive cross‐sectional study of a national sample of privately insured patients. Setting: Outpatient encounters in the United States. Subjects and Methods: Children and adults with outpatient pharmacy‐dispensing claims for new prescriptions of otic or ophthalmic quinolones in 2017 were identified within the IBM MarketScan Commercial Claims & Encounters and the Medicare Supplemental Database. Each dispensing ≥30 days apart constituted a unique episode. Only claims with supporting ear‐related diagnoses on outpatient encounters ±3 days of dispensing were considered. Ophthalmic drops were excluded if eye‐related diagnoses were found ±30 days. Prescribing was classified as appropriate, questionable, or undetermined. Results: We found 214, 897 episodes in 200, 270 patients. Adults were twice as likely as children to have otic treatment with questionable indications (6.2% vs 3.0%). Sensitivity analyses with broader time windows to ascertain diagnoses showed similar proportions of questionable use. Otalgia and cerumen impaction constituted 90% of questionable indications. Family physicians (6.8%) and internists (8.0%) had higher percentages of questionable use than other specialties. Conclusion: Based on the demonstrated risks of quinolone ear drops, opportunities exist to decrease otic quinolone use, especially in adults.