# Paediatric Utilisation of Ophthalmic Antibiotics in the Ear in Aotearoa/New Zealand

## TL;DR

This study examines how ophthalmic antibiotics are used in the ear among young children in New Zealand, revealing patterns and disparities in prescription practices.

## Contribution

The study provides the first description of off-label ophthalmic antibiotic use in the ear among NZ children.

## Key findings

- Most ophthalmic ciprofloxacin was used in the ear, while chloramphenicol was mostly used in the eye.
- Post-operative use accounted for half of hospital-prescribed ciprofloxacin for ear use.
- Pacific children were more likely to receive hospital-prescribed ciprofloxacin for ear use compared to Māori children.

## Abstract

Background/Objectives: Some ophthalmic antibiotics are publicly subsidised in New Zealand (NZ) for off-label use in the ear, however, this utilisation has not previously been described. This study compared the utilisation of ophthalmic chloramphenicol and ciprofloxacin in the eye and ear, among NZ children. Methods: This study involved clinical record review, and included 11,617 prescriptions of ophthalmic chloramphenicol and ciprofloxacin in 2022, for children aged five years or under in Auckland, NZ. Prescriptions of chloramphenicol and ciprofloxacin for eye and ear use were compared by: patient age, gender, ethnicity and socioeconomic deprivation, indication, community or hospital prescribing and number of repeat prescriptions. Statistical analysis was performed using Chi-squared test and multinomial regression. Results: Most ophthalmic ciprofloxacin was used in the ear (84%). In contrast, almost all chloramphenicol was used in the eye (96%). Post-operative use following tympanostomy tube insertion accounted for half of all hospital-prescribed ophthalmic ciprofloxacin used in the ear. Utilisation of chloramphenicol and ciprofloxacin in the eye and ear was similar, with more prescriptions for children aged one year and males, and most children received only one prescription. Māori and Pacific children generally received fewer prescriptions. Pacific children were more likely than Māori children to receive hospital-prescribed ophthalmic ciprofloxacin for use in the ear (adjusted OR 6.7, p = 0.025). Conclusions: These findings highlight the utilisation of ophthalmic ciprofloxacin in the ear in NZ children. These findings will inform decision-making in the public funding of medications, policy development in equitable medication access, and more collaborative efforts to improve antimicrobial use.