Incidence, antimicrobial prescribing practice, and associated healthcare costs of paediatric otorrhoea in primary care in the UK: a longitudinal population study

Elliot Heward; Eleni Domzaridou; Sean P Gavan; Matthew Carr; Judith Lunn; John Molloy; Rachel Isba; Alastair D Hay; Jaya R Nichani; Iain A Bruce; Darren M Ashcroft

doi:10.3399/BJGP.2024.0053

Incidence, antimicrobial prescribing practice, and associated healthcare costs of paediatric otorrhoea in primary care in the UK: a longitudinal population study

Br J Gen Pract. 2024 Dec 13:BJGP.2024.0053. doi: 10.3399/BJGP.2024.0053. Online ahead of print.

Authors

Affiliations

¹ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, and Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester.
² Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, and NIHR Greater Manchester Patient Safety Research Collaboration (PSRC), University of Manchester, Manchester.
³ Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester.
⁴ Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester.
⁵ Lancaster Medical School, Lancaster University, Health Innovation One, Lancaster.
⁶ Lancaster Medical School, Lancaster University, Health Innovation One, Lancaster, and Alder Hey Children's Hospital, Alder Hey Children's NHS Foundation Trust, Liverpool.
⁷ Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol.

Abstract

Background: Paediatric otorrhoea (PO) is a symptom-based diagnosis encompassing acute and chronic ear infections that cause otorrhoea in children and young people (CYP).

Aim: To understand the burden of PO on primary care services.

Design and setting: This was a longitudinal population study in UK primary care.

Method: Data from the Clinical Practice Research Datalink (CPRD Aurum), January 2005 to December 2019, was analysed. CYP <17 years of age with otorrhoea were included. Standardised annual incidence and presentation rates were estimated. Poisson regression modelling was used to determine risk ratios comparing sex, age, and Index of Multiple Deprivation (IMD). A probabilistic simulation scaled-up estimates for the UK population.

Results: The cohort included 6 605 193 CYP, observed over 32 942 594 person-years. There were 80 454 people with incident cases and 106 318 presentations of PO during the 15-year period, equating to standardised annual incidence and presentation rates per 1000 patient-years of 2.42 (95% confidence interval [CI] = 2.40 to 2.44) and 3.15 (95% CI 3.13 to 3.17), respectively. In the UK this equates to 41 141 primary care appointments per year. Incidence was higher in males, those aged 0-2 years, and those living in the least deprived quintile. Treatment involved oral antibiotics (57.1%, 45 931/80 454), no prescription (28.1%, 22 569/80 454), topical antibiotics (9.7%, 7797/80 545), or a combination (4.9%, 3910/80 545). The cost to NHS primary care is estimated at £1.97 million per year.

Conclusion: To the authors' knowledge, this is the first longitudinal population-based study investigating PO that demonstrates the burden on primary care. Antimicrobial prescribing predominantly follows National Institute for Health and Care Excellence guidelines using oral amoxicillin. Aminoglycosides are the most frequently prescribed topical antibiotic despite the concern of ototoxicity.

Keywords: antibiotic resistance; incidence; otitis media, suppurative primary health care.

Grants and funding

This work was supported by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR204036) and the Research Design Service (RDS) public involvement grant (RDSNW3687). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The study sponsor had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Eleni Domzaridou and Darren M Ashcroft are supported by the NIHR Greater Manchester Patient Safety Research Collaboration (PSRC).