Appropriateness of Otic Quinolone Use among Privately Insured US Patients

Otolaryngol Head Neck Surg. 2020 Jan;162(1):102-107. doi: 10.1177/0194599819889607. Epub 2019 Nov 19.

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.

Keywords: off-label; otic quinolone; overprescribing; utilization.

MeSH terms

  • Administration, Ophthalmic
  • Administration, Topical
  • Adult
  • Chi-Square Distribution
  • Child
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Insurance, Pharmaceutical Services / statistics & numerical data
  • Male
  • Otitis Externa / diagnosis
  • Otitis Externa / drug therapy*
  • Otitis Media / diagnosis
  • Otitis Media / drug therapy*
  • Outpatients / statistics & numerical data
  • Patient Safety*
  • Private Sector
  • Quinolones / administration & dosage*
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome
  • United States
  • United States Food and Drug Administration

Substances

  • Quinolones