Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media

Little, Paul; Gould, C.; Williamson, Ian; Moore, Michael; Warner, Greg; Dunleavey, J.

doi:10.1136/bmj.322.7282.336

Cited by 319 publications

(297 citation statements)

References 23 publications

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“…Of the 10 eligible studies, the investigators of 6 studies 30,75,[86][87][88][89] provided the original data requested, and 4 did not. A total of 1642 patients were included in the 6 studies from which data were obtained.…”

Section: Importance Of Accurate Diagnosismentioning

confidence: 99%

“…Greater benefit of immediate antibiotic therapy was observed for bilateral AOM 62,96 or AOM associated with otorrhea. 62 In most randomized trials, 30,75,77,88,89 antibiotic therapy also decreased the duration of pain, analgesic use, or school absence and parent days missed from work.…”

Section: Initial Antibiotic Therapymentioning

confidence: 99%

“…In numerous studies, only approximately one-third of children initially observed received a rescue antibiotic for persistent or worsening AOM, 30,32,76,81,89,102 suggesting that antibiotic use could potentially be reduced by 65% in eligible children. Given the high incidence of AOM, this reduction could help substantially in curtailing antibiotic-related adverse events.…”

Section: Initial Observation For Aommentioning

confidence: 99%

See 2 more Smart Citations

The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

1,087

832

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This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM.In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations.The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships.The practice guideline underwent comprehensive peer review before formal approval by the AAP.This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem. Pediatrics 2013;131:e964-e999

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Section: Importance Of Accurate Diagnosismentioning

confidence: 99%

Section: Initial Antibiotic Therapymentioning

confidence: 99%

Section: Initial Observation For Aommentioning

confidence: 99%

See 1 more Smart Citation

The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

1,087

832

View full text Add to dashboard Cite

show abstract

“…While antibiotics may benefit some children, pain relief is not immediate, the average reduction in duration of pain is only a few hours, and there is no impact on long-term hearing or ear, nose, and throat (ENT) referrals. [2][3][4][5][6][7][8][9][10] However, the NICE guidance does recommend that GPs should 'consider' immediate antibiotic treatment for two groups of children with acute otitis media -the very young (age <2 years) and those with ear discharge. The stated justification for the latter is that a posthoc meta-analysis of the clinical trial data suggests that only three children need to be treated for one less child to experience pain or fever at the 3-7-day assessment point.…”

Section: Introductionmentioning

confidence: 99%

Ear discharge in children presenting with acute otitis media: observational study from UK general practice

Smith¹,

Ewings²,

Smith³

et al. 2010

Br J Gen Pract

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“…[28,41] The use of delayed prescriptions effectively reduced antibiotic use without increasing mortality. [42][43][44] All of these interventions are potentially transferable to LMICs, including SA.…”

Section: Antibiotic Stewardship At the Programmatic Levelmentioning

confidence: 99%

Role of antibiotic stewardship in extending the age of modern medicine

Mendelson

2015

S Afr Med J

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Antibiotic resistance is threatening modern medicine. Overuse and misuse of antibiotics is driving resistance to such an extent that we have entered the post-antibiotic era, where some multidrug-and pandrug-resistant bacterial infections are no longer treatable. If the situation is not reversed, 10 million people will die annually of drug-resistant infections by 2050. More than just a question of mortality, such infections are causing the closure of wards, cancellation of operations, and interference with other common medical procedures that rely on antibiotics for their success. The response to this crisis requires co-ordinated international action with increased surveillance of bacterial resistance, infection prevention, and antibiotic stewardship, i.e. access to affordable, quality-assured antibiotics prescribed appropriately. This review describes antibiotic stewardship at the individual patient and programmatic level, which must be adopted by every prescriber if we are to preserve modern medicine for future generations.

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Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media

Abstract: Objective To compare immediate with delayed prescribing of antibiotics for acute otitis media.

Cited by 319 publications

References 23 publications

The Diagnosis and Management of Acute Otitis Media

The Diagnosis and Management of Acute Otitis Media

Ear discharge in children presenting with acute otitis media: observational study from UK general practice

Role of antibiotic stewardship in extending the age of modern medicine

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