Treatment of Acute Otitis Media in the Pediatric Emergency Department

Rothman, Sarah M.; Pitaro, Jacob; Hackett, Asher; Kozer, Eran; Gavriel, Haim; Muallem‐Kalmovich, Limor; Eviatar, Ephraim; Marom, Tal

doi:10.1097/inf.0000000000001837

Cited by 13 publications

(11 citation statements)

References 23 publications

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“…Still, this project is the first published report conducted in a pediatric UC setting. 9 , 15 , 17 , 22 , 23 This initiative may not be generalizable to all UC centers because ours took place in an extensive academic UC network with a sophisticated EHR and robust QI support. However, these education interventions could be easily replicated to any group of clinicians without significant expense or difficulty.…”

Section: Discussionmentioning

confidence: 99%

Increasing Adherence to Acute Otitis Media Treatment Duration Guidelines using a Quality Improvement Approach

Uhl

Boutzoukas

Gallup

et al. 2021

Pediatric Quality &Amp; Safety

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Section: Discussionmentioning

confidence: 99%

Increasing Adherence to Acute Otitis Media Treatment Duration Guidelines using a Quality Improvement Approach

Uhl

Boutzoukas

Gallup

et al. 2021

Pediatric Quality &Amp; Safety

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“…Another factor that may play a role is doubts regarding follow-up, which lead to more cautious therapeutic and diagnostic plans. In a study that found around 20% of antibiotics were wrongly prescribed, 74% of patients were not examined by a physician prior to the emergency department visit [ 6 ]. This may explain why most of the patients were treated inappropriately.…”

Section: Discussionmentioning

confidence: 99%

Otolaryngologists, Pediatricians, and Emergency and Family Medicine Physicians Adherence to Acute Otitis Media Diagnosis and Management Guidelines: A Retrospective Study in a Saudi Arabian Tertiary Center

Alhammad

AlOtieschan

Alsalim

et al. 2021

Cureus

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BackgroundAcute otitis media (AOM) is one of the most common conditions in the pediatric population and a common reason for physicians to prescribe antibiotics. Most children will develop otitis media at least once during their life. ObjectivesOur study aimed to evaluate and compare the adherence of family medicine physicians, otolaryngologists, pediatricians, and emergency medicine physicians to the American Academy of Pediatrics and American Academy of Family Physicians guidelines for the diagnosis and the management of AOM. MethodsThis is a retrospective study that was conducted at the Ministry of National Guard -Health Affairs affiliated hospitals and primary clinics in Riyadh, Saudi Arabia. All patients diagnosed with AOM and treated between 2016 and 2019 were included in the study. Exclusion criteria included any patient above the age of 18 years old or patients with incomplete data on their files. Variables included demographic data of the patients and treating physicians, associated infections, and whether the treating physician followed the diagnosis and management guidelines. ResultsMost patients were below the age of two years. Emergency medicine physicians were the most common to treat patients with AOM. Although most documentations were sufficient, 39.8% were insufficient or not written. Most (74%) physicians adhered to the diagnosis guidelines, while 57.5% adhered to management guidelines. ConclusionAlthough most physicians adhered to the diagnosis and treatment guidelines, stressing on the matter is essential to avoid unnecessary antibiotics use. We recommend further prospective studies with a bigger sample size of more than one center to have a more accurate reflection of the current situation.

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“…Inappropriate treatment of acute otitis media (AOM) is a well-described phenomenon in the outpatient setting [1][2][3][4][5] and leads to unnecessary adverse drug events and increased bacterial resistance. 6,7 To our knowledge, the treatment of AOM in the inpatient setting, apart from its complications, has not been described.…”

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confidence: 99%

Inpatient Treatment of Acute Otitis Media at a Pediatric Hospital: A Missed Teaching Opportunity for Antimicrobial Stewardship

Miyagami

Williams

Poole

et al. 2020

Hospital Pediatrics

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BACKGROUND: Acute otitis media (AOM) is a common pediatric condition known to contribute to excessive antibiotic use in the outpatient setting. Treatment of AOM in the inpatient setting has not been described. The objective was to describe the clinical features and inpatient management of AOM to harness this entity to teach learners about judicious antibiotic prescribing in all settings.METHODS: This is a single-center retrospective cohort study of inpatients treated for AOM from January 2015 to December 2018. Patients were included if they had an antibiotic ordered and either a provider-selected order indication of otitis media or an International Classification of Diseases, 10th Revision billing code of AOM. A chart review was performed to identify primary diagnoses, examination features, and treatment, including excess days of therapy. RESULTS:We included 840 hospitalized patients treated for AOM in this study. At least 71% of patients had a concurrent viral respiratory illness. Examinations were frequently discordant (34%), and 47% lacked documentation of a physical examination finding of a bulging tympanic membrane, contributing to 3417 potential excess days of therapy. Of the total patients treated for AOM, 40% were given excess duration of therapy. The vast majority (97%) of patients who qualified for a waitand-watch approach were treated. CONCLUSIONS: AOM is not being rigorously diagnosed or treated in a guideline-adherent manner in the inpatient setting. This is a lost opportunity for teaching antibiotic stewardship. Interventions, such as promoting the wait-and-watch approach and deferring treatment decisions to inpatient providers, could help promote the judicious use of antibiotics.

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Treatment of Acute Otitis Media in the Pediatric Emergency Department

Abstract: Adherence rate to the local guidelines treatment recommendations for uncomplicated AOM was high, as measured by whether appropriate treatment was given and type and duration of antibiotics.

Cited by 13 publications

References 23 publications

Increasing Adherence to Acute Otitis Media Treatment Duration Guidelines using a Quality Improvement Approach

Increasing Adherence to Acute Otitis Media Treatment Duration Guidelines using a Quality Improvement Approach

Otolaryngologists, Pediatricians, and Emergency and Family Medicine Physicians Adherence to Acute Otitis Media Diagnosis and Management Guidelines: A Retrospective Study in a Saudi Arabian Tertiary Center

Inpatient Treatment of Acute Otitis Media at a Pediatric Hospital: A Missed Teaching Opportunity for Antimicrobial Stewardship

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