Observation Option for Acute Otitis Media in the Emergency Department

Fischer, Thomas; Singer, Adam J.; Chale, Stuart

doi:10.1097/pec.0b013e3181b91ff0

Cited by 17 publications

(10 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We were unable to obtain data from nine eligible studies because of no response (n=6), researchers moving on (n=2), or no response after initial agreement (n=1). 50 51 52 53 54 55 56 57 58 …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis

Stuart

Hounkpatin

Becque

et al. 2021

BMJ

View full text Add to dashboard Cite

Objective To assess the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community, and to identify any factors modifying this effect. Design Systematic review and individual patient data meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Ovid Medline, Ovid Embase, EBSCO CINAHL Plus, and Web of Science. Eligibility criteria for study selection Randomised controlled trials and observational cohort studies in a community setting that allowed comparison between delayed versus no antibiotic prescribing, and delayed versus immediate antibiotic prescribing. Main outcome measures The primary outcome was the average symptom severity two to four days after the initial consultation measured on a seven item scale (ranging from normal to as bad as could be). Secondary outcomes were duration of illness after the initial consultation, complications resulting in admission to hospital or death, reconsultation with the same or worsening illness, and patient satisfaction rated on a Likert scale. Results Data were obtained from nine randomised controlled trials and four observational studies, totalling 55 682 patients. No difference was found in follow-up symptom severity (seven point scale) for delayed versus immediate antibiotics (adjusted mean difference −0.003, 95% confidence interval −0.12 to 0.11) or delayed versus no antibiotics (0.02, −0.11 to 0.15). Symptom duration was slightly longer in those given delayed versus immediate antibiotics (11.4 v 10.9 days), but was similar for delayed versus no antibiotics. Complications resulting in hospital admission or death were lower with delayed versus no antibiotics (odds ratio 0.62, 95% confidence interval 0.30 to 1.27) and delayed versus immediate antibiotics (0.78, 0.53 to 1.13). A significant reduction in reconsultation rates (odds ratio 0.72, 95% confidence interval 0.60 to 0.87) and an increase in patient satisfaction (adjusted mean difference 0.09, 0.06 to 0.11) were observed in delayed versus no antibiotics. The effect of delayed versus immediate antibiotics and delayed versus no antibiotics was not modified by previous duration of illness, fever, comorbidity, or severity of symptoms. Children younger than 5 years had a slightly higher follow-up symptom severity with delayed antibiotics than with immediate antibiotics (adjusted mean difference 0.10, 95% confidence interval 0.03 to 0.18), but no increased severity was found in the older age group. Conclusions Delayed antibiotic prescribing is a safe and effective strategy for most patients, including those in higher risk subgroups. Delayed prescribing was associated with similar symptom duration as no antibiotic prescribing and is unlikely to lead to poorer symptom control than immediate antibiotic prescribing. Delayed prescribing could reduce reconsultation rates and is unlikely to be associated with an increase in symptoms or illness duration, except in young children. Study registration PROSPERO CRD42018079400.

show abstract

Section: Resultsmentioning

confidence: 99%

“…634353637383940414243444546474849 IPD were obtained from 13 studies (nine RCTs, four observational studies; table 1), totalling 55 682 participants. We were unable to obtain data from nine eligible studies because of no response (n=6), researchers moving on (n=2), or no response after initial agreement (n=1) 505152535455565758…”

Section: Resultsmentioning

confidence: 99%

Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis

Stuart

Hounkpatin

Becque

et al. 2021

BMJ

View full text Add to dashboard Cite

show abstract

“…Interventions with a significant effect on antibiotic reduction were guidelines and the wait-and-see prescription in acute otitis media (AOM). For this latter a significant reduction was found in four articles (three of them with moderate to high quality) ( 29 , 34 , 52 , 66 ).…”

Section: Resultsmentioning

confidence: 94%

“…Nine out of 27 studies on interventions for antibiotic prescription (32%) reported about rapid viral testing ( 22 , 24 , 25 , 27 , 33 , 40 , 58 , 62 , 64 ), four about delayed antibiotic prescription in acute otitis media ( 29 , 34 , 52 , 66 ), six about guideline/management strategies ( 20 , 21 , 41 , 53 , 59 , 68 ), four about laboratory tests ( 22 , 46 , 47 , 49 ) and five using other interventions (Table 4 ). In fourteen studies (50%) a significant reduction in antibiotic use was found.…”

Section: Resultsmentioning

confidence: 99%

Antibiotic Use in Febrile Children Presenting to the Emergency Department: A Systematic Review

et al. 2018

View full text Add to dashboard Cite

Introduction: While fever is the main complaint among pediatric emergency services and high antibiotic prescription are observed, only a few studies have been published addressing this subject. Therefore this systematic review aims to summarize antibiotic prescriptions in febrile children at the ED and assess its determinants.Methods: We extracted studies published from 2000 to 2017 on antibiotic use in febrile children at the ED from different databases. Author, year, and country of publishing, study design, inclusion criteria, primary outcome, age, and number of children included in the study was extracted. To compare the risk-of-bias all articles were assessed using the MINORS criteria. For the final quality assessment we additionally used the sample size and the primary outcome.Results: We included 26 studies reporting on antibiotic prescription and 28 intervention studies on the effect on antibiotic prescription. In all 54 studies antibiotic prescriptions in the ED varied from 15 to 90.5%, pending on study populations and diagnosis. Respiratory tract infections were mostly studied. Pediatric emergency physicians prescribed significantly less antibiotics then general emergency physicians. Most frequent reported interventions to reduce antibiotics are delayed antibiotic prescription in acute otitis media, viral testing and guidelines.Conclusion: Evidence on antibiotic prescriptions in children with fever presenting to the ED remains inconclusive. Delayed antibiotic prescription in acute otitis media and guidelines for fever and respiratory infections can effectively reduce antibiotic prescription in the ED. The large heterogeneity of type of studies and included populations limits strict conclusions, such a gap in knowledge on the determining factors that influence antibiotic prescription in febrile children presenting to the ED remains.

show abstract

“…Studies by other authors also demonstrate that wait-and-see approach to treatment of AOM in children is entirely acceptable. In one study Fischer T. and colleagues followedup 145 children with AOM that resolved spontaneously without any need for antibiotic treatment in 73% of cases [14], while in another study, Spiro D. M. and colleagues from USA followed-up 283 children and did not use any antibiotics in 62% of patients, but still achieved resolution of AOM [15]. The results of other studies are in accordance with the above data and suggest that spontaneous resolution within 7-14 days occurs in 70-90% of patients with AOM, in cases of first occurrence and sporadic AOM [16][17][18].…”

Section: Discussionmentioning

confidence: 98%