educational series | acute otitis externa (aoe): topical therapy & systemic antimicrobial...

11 measures Antibiotic

Stewardship• #66: Pharyngitis patients

given an abx who had strep test performed

• #91: Patients with Otitis Externa given a topical abx

• #93: Patients with Otitis Externa not given a systemic abx

• #116: 18-64 y/o with bronchitis not given abxwithin 3 days of encounter

Choosing Wisely:Head CT Utilization

• #416: 2-17 y/o with appropriate head CT for blunt head trauma (PECARN rules)

• #415: 18+ y/o with appropriate head CT ordering for blunt head trauma

PregnancyMeasures

• #254: US localization of pregnancy in pregnant pts with abd pain

• #255: Rhogam for Rh negative patients at risk

Miscellaneous

• #54: EKG for non-traumatic chest pain

• #76: Proper sterile technique for CVC placement

• #317: BP Screening and follow up documented

#91 Acute Otitis Externa (AOE): Topical Therapy

AND

#93 Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy

Week 4

#91:Acute Otitis Externa (AOE): Topical Therapy

Percentage of patients prescribed a topical

preparation forAcute Otitis Externa

#91:Acute Otitis Externa (AOE): Topical Therapy

Simple otitis externa should be treated with

topical preparations alone

Clinical Practice Guideline by the American Academy of

Otolaryngology-Head andNeck Surgery

#91:Inclusion

Numerator:Patients prescribed (or currently taking) a topical preparation for AOE

Denominator:1. Patients > 2 years old2. Patients diagnosed with AOE

#91:Exclusions: (measure is not coded/does not apply)

1. Coexisting Otitis Media or other infectious process (and systemic antibiotics ordered)

2. Ruptured Tympanic Membrane (although non ototoxic preparation such as fluoroquinolone may be used)

3. Documented patient reason such as patient not capable of compliance (would be uncommon situation)

#91:Note

Realize the only requirement here is ordering a topical

preparation, which doesn't need to be an antibiotic and can be

OTC (such as acetic acid).

Best PracticesAs always, remember good documentation!

Best practice:1. “Patient with simple otitis externa, cortisporin prescribed.”

2. “Patient with otitis media, systemic antibiotic prescribed.” (this would be an exclusion of the measure, and one may prescribe a topical preparation in addition to the systemic antibiotic)

Not Acceptable:1. No topical agent given without documentation of valid reason.

#93:Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy

Systemic antibiotics are not recommended in cases of

uncomplicated otitis externa.

#93:Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy

Avoiding systemic antibiotics in AOE is included in the Choosing

Wisely Campaign for the American Academy of

Otolaryngology-Head andNeck Surgery

AAO-HNS Choosing Wisely List

#93:Inclusion

Numerator: Patients with simple AOE who are not prescribed systemic antibiotic therapy

Denominator:1. Patients > 2 years old2. Patients diagnosed with AOE

#93:Exclusion: Medical Reason Documented

1. Other infection documented (for example cellulitis, otitis media, pharyngitis)

2. OE is complicated (cellulitis, foreign body)

3. Immunocompromised (Diabetes, immune deficiency)

#93:Note

Physician judgment is most important. If a systemic

antibiotic is needed, clearly document the reason and you

should be in good shape.

Best PracticesAs always, documentation is the key!

Best practice:1. “Patient with simple otitis externa, no oral antibiotic indicated.”2. Not prescribing systemic antibiotic without comment is acceptable.3. “Patient with poorly controlled diabetes mellitus, Keflex prescribed in addition to Cipro Otic

drops.” (Exclusion)

Not Acceptable:1. “Patient with severe pain and oral antibiotic prescribed.”2. Oral antibiotic given without reason.