Heward Elliot, Domzaridou Eleni, Gavan Sean P, Carr Matthew, Lunn Judith, Molloy John, Isba Rachel, Hay Alastair D, Nichani Jaya R, Bruce Iain A, Ashcroft Darren M
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.
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.
Br J Gen Pract. 2025 Jan 30;75(751):e113-e121. doi: 10.3399/BJGP.2024.0053. Print 2025 Feb.
Paediatric otorrhoea (PO) is a symptom-based diagnosis encompassing acute and chronic ear infections that cause otorrhoea in children and young people (CYP).
To understand the burden of PO on primary care services.
This was a longitudinal population study in UK primary care.
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.
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.
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.
小儿耳漏（PO）是一种基于症状的诊断，涵盖导致儿童和青少年耳漏的急性和慢性耳部感染。
了解小儿耳漏对基层医疗服务的负担。
这是一项在英国基层医疗中进行的纵向人群研究。
分析了临床实践研究数据链（CPRD Aurum）2005年1月至2019年12月的数据。纳入了17岁以下有耳漏的儿童和青少年。估计了标准化年发病率和就诊率。采用泊松回归模型确定比较性别、年龄和多重剥夺指数（IMD）的风险比。通过概率模拟扩大了对英国人群的估计。
该队列包括6605193名儿童和青少年，观察时间超过32942594人年。在15年期间，有80454例新发病例和106318次小儿耳漏就诊，相当于每1000患者年的标准化年发病率和就诊率分别为2.42（95%置信区间[CI]=2.40至2.44）和3.15（95%CI 3.13至3.17）。在英国，这相当于每年41141次基层医疗预约。男性、0至2岁儿童以及生活在最不贫困五分之一地区的人群发病率较高。治疗方法包括口服抗生素（57.1%，45931/80454）、无处方（28.1%，22569/80454）、外用抗生素（9.7%，7797/80545）或联合用药（4.9%，391零/80545）。英国国民保健制度基层医疗的成本估计为每年197万英镑。
据作者所知，这是第一项基于人群的纵向研究小儿耳漏，证明了其对基层医疗的负担。抗菌药物处方主要遵循英国国家卫生与临床优化研究所使用口服阿莫西林的指南。尽管担心耳毒性，但氨基糖苷类是最常用的外用抗生素。
