2975-LB: Management of Acute Otitis Externa in Patients With and Without Diabetes: A Cross-Sectional Survey of Primary Care Clinicians

Introduction and Objective: Acute otitis externa is commonly encountered in primary care and is effectively treated with topical therapy. Diabetes is a known risk factor for necrotizing otitis externa and may influence clinician decision-making despite guideline recommendations. The objective of this study was to determine whether the presence of diabetes is associated with increased use of systemic antibiotics for uncomplicated acute otitis externa in adults managed in primary care. Methods: A cross-sectional, anonymous survey was distributed to primary care clinicians within a practice-based research network. Respondents evaluated standardized clinical scenarios describing uncomplicated acute otitis externa in adults with and without diabetes. The primary outcome was selection of any systemic antibiotic therapy. Differences by diabetes status were assessed using Fisher exact test, with relative risk and 95% confidence intervals reported. Results: Fifty-eight clinicians completed the survey. Systemic antibiotic therapy was selected more frequently when diabetes was present compared with no diabetes (19% vs 5%). Diabetes was associated with a significantly increased likelihood of systemic antibiotic use (relative risk 3.67; 95% CI, 1.08-12.47; p = 0.043). Most respondents reported low to moderate confidence in identifying necrotizing otitis externa. Patient-specific factors, including glycemic control and comorbidities, most strongly influenced treatment decisions. Conclusion: Clinicians reported higher use of systemic antibiotics for uncomplicated acute otitis externa when diabetes was present, despite guideline recommendations favoring topical therapy alone. Given the high prevalence of diabetes in primary care, small deviations from guideline-based management may result in meaningful cumulative antibiotic exposure at the population level. These findings highlight an opportunity for targeted education and decision support to promote appropriate antibiotic use. Disclosure B.T. Burroughs: None. A. Misra: None. P. Badar: None. N. Ganne: None.