Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity

Tamir, Sharon Ovnat; Shemesh, Shay; Oron, Yahav; Marom, Tal

doi:10.1136/archdischild-2016-310729

Cited by 49 publications

(28 citation statements)

References 21 publications

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“…Previously published works demonstrated a common consensus in criteria for AOM diagnosis, and that a watchful waiting period was the standard of care in Europe; amoxicillin was also found to be the most commonly recommended antibiotic 43–45. In comparison with these studies, our work aimed to compare additional facets of AOM management in Europe, including grading their quality, comparison of LoE and SoR and assessing their inclusion of country-specific AMR data.…”

Section: Discussionmentioning

confidence: 99%

Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines

et al. 2020

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ObjectivesTo appraise European guidelines for acute otitis media (AOM) in children, including methodological quality, level of evidence (LoE), astrength of recommendations (SoR), and consideration of antibiotic stewardship.DesignSystematic review of the literature.Data sourcesThree-pronged search of (1) databases: Medline, Embase, Cochrane library, Guidelines International Network and Trip Medical Database; (2) websites of European national paediatric associations and (3) contact of European experts. Data were collected between January 2017 and February 2018.Eligibility criteriaNational guidelines of European countries for the clinical management of AOM in children aged <16 years.Data extraction and synthesisData were extracted using tables constructed by the research team. Guidelines were graded using AGREE II criteria. LoE and SoR were compared. Guidelines were assessed for principles of antibiotic stewardship.ResultsAOM guidelines were obtained from 17 or the 32 countries in the European Union or European Free Trade Area. The mean AGREE II score was ≤41% across most domains. Diagnosis of AOM was based on similar signs and symptoms. The most common indication for antibiotics was tympanic membrane perforation/otorrhoea (14/15; 93%). The majority (15/17; 88%) recommended a watchful waiting approach to antibiotics. Amoxicillin was the most common first-line antibiotic (14/17; 82%). Recommended treatment duration varied from 5 to 10 days. Seven countries advocated high-dose (75–90 mg/kg/day) and five low-dose (30–60 mg/kg/day) amoxicillin. Less than 60% of guidelines used a national or international scale system to rate level of evidence to support recommendations. Under half of the guidelines (7/17; 41%) referred to country-specific microbiological and antibiotic resistance data.ConclusionsGuidelines for managing AOM were similar across European countries. Guideline quality was mostly weak, and it often did not refer to country-specific antibiotic resistance patterns. Coordinating efforts to produce a core guideline which can then be adapted by each country may help improve overall quality and contribute to tackling antibiotic resistance.

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Section: Discussionmentioning

confidence: 99%

Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines

et al. 2020

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“…As a consequence, clinical practice guidelines for common infectious diseases, including acute otitis media (AOM), have been introduced and updated in many countries over the past decades. 1 Although AOM guidelines vary regarding specific recommendations across countries, they generally emphasise the importance of accurate diagnosis and adequate analgesia as well as advocating selective antibiotic prescribing. 1 …”

Section: Introductionmentioning

confidence: 99%

“… 1 Although AOM guidelines vary regarding specific recommendations across countries, they generally emphasise the importance of accurate diagnosis and adequate analgesia as well as advocating selective antibiotic prescribing. 1 …”

Section: Introductionmentioning

confidence: 99%

Impact of acute otitis media clinical practice guidelines on antibiotic and analgesic prescriptions: a systematic review

et al. 2018

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BackgroundClinical practice guidelines focusing on judicious use of antibiotics for childhood acute otitis media (AOM) have been introduced in many countries around the world.ObjectiveTo systematically review the effects of these guidelines on the prescription of antibiotics and analgesics for children with AOM.MethodsSystematic searches of PubMed, Embase and Cochrane Library from inception to 6 June 2017 using broad search terms. Studies specifically aimed at evaluating the effects of introduction of national AOM practice guidelines on type of antibiotic and/or analgesic prescriptions were included, irrespective of design, setting or language. The Risk Of Bias In Non-randomized Studies of Interventions tool was used to assess risk of bias.ResultsOf 411 unique records retrieved, seven studies conducted in six different countries (France, Italy, Spain, Sweden, UK and USA (twice)) compared data before and after guideline introduction. All studies had an observational design, using longitudinal data of children aged under 15 years (n=200–4.6 million) from either routine care, insurance databases or electronic surveys. Risk of bias of all studies was judged serious to critical.Of the five studies reporting on antibiotic prescription rates, three showed a decline of 5%–12% up to 3 years after guideline introduction and two found no or negligible effect. In one US study, the initial 9% decline decreased to 5% after 4–6 years. The recommended first choice antibiotic was prescribed more frequently (9%–58% increase) after guideline introduction in four out of five studies reporting on this outcome. Analgesic prescription rates for AOM were reported in one US study and increased from 14% to 24% after guideline introduction.ConclusionBased upon what is published, the effects of introduction of national clinical practice guidelines on antibiotic and analgesic prescribing for children with AOM seem modest at the most.RegistrationPROSPERO: CRD42016050976.

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“…AOM is the most common bacterial infection in children 2–6. Consequently, AOM is the most common reason for antibiotic prescription in the pediatric age 7,8. Almost all children may experience at least one episode of AOM during the childhood.…”

Section: Introductionmentioning

confidence: 99%

Bacteriotherapy with <em>Streptococcus salivarius</em> 24SMB and <em>Streptococcus oralis</em> 89a nasal spray for preventing recurrent acute otitis media in children: a real-life clinical experience

Mantia¹,

Varricchio²,

Ciprandi³

2017

IJGM

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Recurrence of acute otitis media (RAOM) is a relevant issue in the clinical practice. “Bacteriotherapy” has been proposed as an option in children with RAOM. Streptococcus salivarius 24SMB nasal spray has been previously demonstrated to reduce the risk of acute otitis media (AOM) in otitis-prone children. The current retrospective and observational study aimed to confirm this outcome in a real-life setting, such as the common pediatric practice. Group A (108 children) served as control; group B (159 children) was treated with S. salivarius 24SMB and Streptococcus oralis 89a nasal spray after the first AOM episode. Active treatment consisted of 3 monthly courses: 2 puffs per nostril twice/day for a week. Group B showed a significant reduction of AOM episodes in comparison with group A (p<0.0001). Notably, all actively treated children with the highest AOM recurrence had a reduction of recurrence, whereas only 50% of the control group children had reduced RAOM (p<0.0001). Also, severity grade of AOM significantly diminished after the preventive bacteriotherapy (p<0.0001). In conclusion, the current retrospective and observational study demonstrated that S. salivarius 24SMB and S. oralis 89a nasal spray could be effective in the prevention of RAOM in a real-life setting.

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Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity

Abstract: Guidelines for AOM from developing and developed countries are similar in many aspects, with variation in specific recommendations, due to local epidemiology and healthcare accessibility. Formulation of regional guidelines may help reduce AOM burden.

Cited by 49 publications

References 21 publications

Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines

Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines

Impact of acute otitis media clinical practice guidelines on antibiotic and analgesic prescriptions: a systematic review

Bacteriotherapy with <em>Streptococcus salivarius</em> 24SMB and <em>Streptococcus oralis</em> 89a nasal spray for preventing recurrent acute otitis media in children: a real-life clinical experience

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