Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

Brinker, David L.; MacGeorge, Erina L.; Hackman, Nicole M.

doi:10.1177/0009922818806312

Cited by 17 publications

(14 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…20 In this study, more than 80% of OM diagnoses received antibiotic prescriptions, and at UCC and PMD, almost 40% were for non–first-line agents. Recent analyses find that WW is appropriate for most OM cases by guideline criteria, but is rarely used 13,21 ; WW has also been shown to be safe and cost-effective at a programmatic/societal level. 13 In addition to encouraging delayed prescribing for less severe OM cases, avoiding the regular use of azithromycin and oral third-generation cephalosporins (~29% at PMD and UCC) stands to be reinforced, as these non–first-line agents may be not only excessively broad-spectrum, but also less effective.…”

Section: Discussionmentioning

confidence: 99%

Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a Pediatric Emergency Department

Islam

Mannix

Breuer

et al. 2019

Clin Pediatr (Phila)

View full text Add to dashboard Cite

Pediatric antibiotic prescriptions originate from an increasingly broad range of ambulatory settings. In this retrospective study, pharyngitis, otitis media, sinusitis, pneumonia, and upper respiratory infection cases, at 11 primary care offices, 2 independent urgent care centers (UCCs), and a pediatric emergency department in Western New York, were analyzed relative to medical society practice guidelines and antibiotic utilization. Of 2358 eligible visits across all sites, 25% were for study diagnoses, with 38% at UCC ( P < .01). Across all sites, 26% of pharyngitis cases given antibiotics did not have diagnostic evidence of bacterial infection. At primary care offices and UCCs, guideline recommended first-line agents for pharyngitis and otitis media were used in only 58% and 63% of treated cases, respectively. Overall, an estimated 9855 to 12 045 avoidable antibiotic and 8030 non-guideline antibiotic courses annually are represented by the 14 sites studied. These and other study findings highlight numerous opportunities for outpatient pediatric antibiotic stewardship.

show abstract

Section: Discussionmentioning

confidence: 99%

Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a Pediatric Emergency Department

Islam

Mannix

Breuer

et al. 2019

Clin Pediatr (Phila)

View full text Add to dashboard Cite

show abstract

“…Está ultima es una medida de la carga de morbilidad expresada en años de vida perdidos por mortalidad prematura o cualquier discapacidad causada por una enfermedad (16). A pesar de que se ha evidenciado que dar instrucciones a los padres de diferir el tratamiento antibiótico efectivamente reduce y retrasa el despacho de antibióticos (en un 39.5% y 38.9% respectivamente) y que dicha recomendación fue propuesta por la AAP desde el año 2004, en la práctica actual poco más del 16% de los padres cuyos hijos califican para espera vigilante reciben instrucciones de aplazar el tratamiento antibiótico (17). Incluso hay estudios que reportan porcentajes menores a 5% (16).…”

Section: Manejounclassified

“…El cefdinir posee una actividad algo superior a la amoxicilina para Hint, pero inferior para SP, y se ha estimado una cobertura de aproximadamente 85% de todos los Hint, la mayoría de MC y 50-75% de SP con concentraciones inhibitorias mínimas de penicilina menores a 0.5 µg/mL. Por otra parte, el costo de cefdinir es hasta 6 veces mayor que el de amoxicilina, pero un 15% menos que el de amoxicilinaclavulanato (17) El SP resistente a la penicilina se considera en la actualidad la causa principal de fracaso terapéutico de los antibióticos en la OMA (5). Algunos estudios han evidenciado que en los países donde se aplica la vacuna antineumocócica conjugada heptavalente (PCV7) de forma efectiva y rutinaria, existe una menor proporción de infecciones neumocócicas causadas por los serotipos contenidos en dicha vacuna, y un aumento en la incidencia de otros serotipos como el 19A y el 3 (5,7,19).…”

Section: Principales Antibióticos Utilizados En Omaunclassified

Otitis media aguda: generalidades y resistencia antibiótica

Solano

Visbal²,

Mejía

2019

Rev.méd.sinerg.

View full text Add to dashboard Cite

La otitis media (OM) es uno de los diagnósticos más comunes en pediatría y constituye la indicación más frecuente de prescripción de antibióticos en la infancia. Para el diagnóstico de la otitis media aguda (OMA) se tienen en cuenta hallazgos de la otoscopia, diversos signos clínicos y el tiempo de evolución de los síntomas principales. La decisión de iniciar antibioticoterapia debe fundamentarse en la estratificación de riesgo del paciente. La espera vigilante como alternativa a la antibioticoterapia inmediata en casos seleccionados reduce el uso de antibióticos sin aumentar el riesgo de daño al paciente y ha demostrado ser una medida costo-efectiva. El fármaco de elección para el tratamiento empírico de la OMA es la amoxicilina. Otras alternativas frecuentemente utilizadas son las cefalosporinas, macrólidos o combinaciones con inhibidores de β-lactamasas. El Streptococcus pneumoniae resistente a la penicilina se considera la causa principal de fracaso terapéutico de los antibióticos en la OMA. Con la introducción de la vacuna antineumocócica conjugada heptavalente se han observado cambios en la frecuencia de determinados serotipos de Streptococcus pneumoniae y un aumento en el aislamiento de Haemophilus influenzae en las muestras de fluido del oído medio de paciente con OMA. Estudios recientes han evidenciado el aumento en la prevalencia de agentes productores de β-lactamasas en pacientes con OMA.

show abstract

“…Despite the frequency of such encounters, the medical literature suggests that the diagnostic accuracy for such pathology is only around 46-56%. In alignment with the bias toward over-diagnosis of ear disease, it is currently estimated that between 25-50% of all antibiotics prescribed for ear disease are not indicated (1)(2)(3). Beyond risking unnecessary medical complications and the downstream unintended consequence of potential antibiotic resistance, over-diagnosis of ear disease adds an estimated $59 million in unnecessary healthcare spending in the US per annum (4).…”

Section: Introductionmentioning

confidence: 99%

Pediatric Otoscopy Video Screening With Shift Contrastive Anomaly Detection

Wang

Tamhane

Santos

et al. 2022

Front. Digit. Health

View full text Add to dashboard Cite

Ear related concerns and symptoms represent the leading indication for seeking pediatric healthcare attention. Despite the high incidence of such encounters, the diagnostic process of commonly encountered diseases of the middle and external presents a significant challenge. Much of this challenge stems from the lack of cost effective diagnostic testing, which necessitates the presence or absence of ear pathology to be determined clinically. Research has, however, demonstrated considerable variation among clinicians in their ability to accurately diagnose and consequently manage ear pathology. With recent advances in computer vision and machine learning, there is an increasing interest in helping clinicians to accurately diagnose middle and external ear pathology with computer-aided systems. It has been shown that AI has the capacity to analyze a single clinical image captured during the examination of the ear canal and eardrum from which it can determine the likelihood of a pathognomonic pattern for a specific diagnosis being present. The capture of such an image can, however, be challenging especially to inexperienced clinicians. To help mitigate this technical challenge, we have developed and tested a method using video sequences. The videos were collected using a commercially available otoscope smartphone attachment in an urban, tertiary-care pediatric emergency department. We present a two stage method that first, identifies valid frames by detecting and extracting ear drum patches from the video sequence, and second, performs the proposed shift contrastive anomaly detection (SCAD) to flag the otoscopy video sequences as normal or abnormal. Our method achieves an AUROC of 88.0% on the patient level and also outperforms the average of a group of 25 clinicians in a comparative study, which is the largest of such published to date. We conclude that the presented method achieves a promising first step toward the automated analysis of otoscopy video.

show abstract

Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

Cited by 17 publications

References 14 publications

Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a Pediatric Emergency Department

Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a Pediatric Emergency Department

Otitis media aguda: generalidades y resistencia antibiótica

Pediatric Otoscopy Video Screening With Shift Contrastive Anomaly Detection

Contact Info

Product

Resources

About