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. 2025 Jan 30;75(751):e113-e121.
doi: 10.3399/BJGP.2024.0053. Print 2025 Feb.

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

Elliot Heward  1 , Eleni Domzaridou  2 , Sean P Gavan  3 , Matthew Carr  4 , Judith Lunn  5 , John Molloy  1 , Rachel Isba  6 , Alastair D Hay  7 , Jaya R Nichani  1 , Iain A Bruce  1 , Darren M Ashcroft  2
Affiliations

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

Elliot Heward et al. Br J Gen Pract. .

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.

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Conflict of interest statement

The authors have declared no competing interests.

Figures

Figure 1.
Figure 1.
Overall standardised annual incidence and presentation rates.
Figure 2.
Figure 2.
Annual standardised incidence rates by a) age (years), b) sex, and c) deprivation quintile. IMD = Index of Multiple Deprivation.
Figure 3.
Figure 3.
Annual rates of a) oral and b) topical antibiotic prescriptions.
See this image and copyright information in PMC

Comment in

  • Treating paediatric otorrhoea.
    Zermansky A. Zermansky A. Br J Gen Pract. 2025 May 2;75(754):204. doi: 10.3399/bjgp25X741405. Print 2025 May. Br J Gen Pract. 2025. PMID: 40316341 No abstract available.

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