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No sponsorships or competing interests have been disclosed for this article. Objective. Acute otitis externa (AOE) is a common but pre-ventable ear condition. Clinical guidelines issued in 2006 recommended topical treatments for uncomplicated AOE, but systemic antimicrobials appear to be commonly pre-scribed. The objective of this analysis was to describe pre-and postguideline prescribing patterns by clinician specialty and antimicrobial type and assess trends over time. Study Design. Retrospective longitudinal analysis of a large insurance database. Setting. Outpatient departments in the United States. Methods. Initial outpatient visits in 2004 to 2010 for AOE (excluding visits with complicating conditions) were extracted from an insurance database. Prescription drug claims wer