Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Faculty of Pharmacy, Ho Chi Minh City University of Technology, Ho Chi Minh City, Vietnam.
Otolaryngol Head Neck Surg. 2020 Jan;162(1):102-107. doi: 10.1177/0194599819889607. Epub 2019 Nov 19.
Considering emerging safety concerns involving otic quinolones, we assessed the extent of otic quinolone use for questionable indications.
Descriptive cross-sectional study of a national sample of privately insured patients.
Outpatient encounters in the United States.
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.
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.
Based on the demonstrated risks of quinolone ear drops, opportunities exist to decrease otic quinolone use, especially in adults.
鉴于耳用喹诺酮类药物出现新的安全性问题，我们评估了这些药物在可疑适应证中的使用程度。
对美国门诊患者的全国性样本进行描述性横断面研究。
在美国的门诊就诊。
在 IBM MarketScan 商业索赔和就诊数据库以及 Medicare 补充数据库中，确定了 2017 年有新的耳用或眼用喹诺酮类药物处方配药的门诊药房配药的儿童和成人患者。≥30 天的每次配药构成一个独特的疗程。只有在配药前后±3 天的门诊就诊中发现与耳部相关的诊断，才可认为处方合理。如果在±30 天内发现与眼部相关的诊断，则排除眼用滴剂。将处方分为合理、可疑和未确定。
我们在 200,270 名患者中发现了 214,897 个疗程。与儿童相比，成年人更有可能因可疑适应证而接受耳部治疗（6.2%对 3.0%）。在使用更宽的时间窗口来确定诊断的敏感性分析中，可疑使用的比例也相似。耳痛和耳垢栓塞占可疑适应证的 90%。家庭医生（6.8%）和内科医生（8.0%）的可疑使用比例高于其他专科医生。
鉴于耳用喹诺酮类药物的风险已得到证实，减少耳用喹诺酮类药物的使用，特别是在成人中，是有机会的。
