Short-course antibiotics for acute otitis media
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 8226a Aberhart Centre, 11402 University Ave, Edmonton, Alberta, Canada, T6G 2J3. Cochrane database of systematic reviews (Online)
(Impact Factor: 6.03).
09/2010; DOI: 10.1002/14651858.CD001095.pub2
Acute otitis media (AOM), or middle ear infection, is a common childhood illness, with more than half of all children having at least one infection by the time they are seven. Although otitis media often resolves without treatment, it is frequently treated with antibiotics. The length of treatment varies widely. This review of 49 trials found that treating children with a short course (less than seven days) of antibiotics, compared to treatment with a long course (seven days or greater) of antibiotics, increases the likelihood of treatment failure in the short term. No differences are seen one month later. The amount of gastrointestinal adverse events decreased with a shorter course of antibiotics.
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ABSTRACT: Our goal was to quantify the evidence that is available to the physicians of a pediatric emergency department (PED) in making treatment decisions. Further, we wished to ascertain what percentage of evidence for treatment provided in the PED comes from pediatric studies.
We conducted a retrospective chart review of randomly selected patients seen in the PED between January 1 and December 31, 2002. The principal investigator identified a primary diagnosis and primary intervention for each chart. A thorough literature search was then undertaken with respect to the primary intervention. If a randomized control trial (RCT) or a systematic review was found, the intervention was classified as level I evidence. If no RCT was found, the intervention was assessed by an expert committee who determined its appropriateness based on face validity (RCTs were unanimously judged to be both unnecessary and, if a placebo would have been involved, unethical). These interventions were classified as level II evidence. Interventions that did not fall into either above category were classified as level III evidence.
Two hundred and sixty-two patient charts were reviewed. Of these, 35.9% did not receive a primary intervention. Of the 168 interventions assessed, 80.4% were evidence-based (level I), 7.1% had face validity (level II) and 12.5% had no supporting evidence (level III). Of the evidence-based interventions, 83.7% were supported by studies with mostly pediatric patients.
Our study demonstrates that a substantial proportion of PED treatment decisions are evidence-based, with most based on studies in pediatric patients. Also, a large number of patients seen in the PED receive no intervention.
BMC Pediatrics 02/2006; 6(1):26. DOI:10.1186/1471-2431-6-26 · 1.93 Impact Factor
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ABSTRACT: Zusammenfassung Die akute Otitis media (AOM) ist im Kindesalter eine der häufigsten Ursachen für Besuche beim niedergelassenen Arzt. Zur Prophylaxe
nützlich sind Stillen und Vermeiden von Tabakrauchbelastung. Zur Behandlung der AOM im Kindesalter existieren viele unterschiedliche
Empfehlungen, die nur z. T. auf aktuellen Studienergebnissen basieren. Wir berücksichtigen wissenschaftliche Literatur der
höchsten Evidenzstufe, nämlich Metaanalysen randomisierter Studien und einzelne randomisierte Studien. Eine kausale antibiotische
Therapie ist zu empfehlen bei einer AOM in Verbindung mit einer Otorrhö sowie bei einer bilateralen AOM von Kindern unter
2 Jahren. Bei Kindern über 2 Jahren ohne besondere Risikofaktoren kann im Sinne einer Nutzen-Risiko-Abwägung anfangs auf eine
antibiotische Therapie verzichtet werden, wobei eine Verlaufskontrolle zu empfehlen ist. Ohrenschmerzen können wirkungsvoll
mit Paracetamol oder Ibuprofen gelindert werden.
Monatsschrift Kinderheilkunde 06/2008; 156(6):540-544. DOI:10.1007/s00112-008-1753-4 · 0.23 Impact Factor
Available from: Milo A Puhan
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ABSTRACT: Randomised trials comparing different drugs head-to-head are extremely valuable for clinical decision-making. However, it is scientifically and ethically sensible to demand strong evidence that a drug is effective by showing superiority over a placebo before embarking on head-to-head comparisons of potentially ineffective drugs. Our aim was to study the evolvement of evidence from placebo-controlled and head-to-head trials on the effects of antibiotics for the treatment of mild to moderate exacerbations of chronic obstructive pulmonary disease.
We conducted a historical systematic review. Through electronic databases and hand-searches, we identified placebo-controlled and head-to-head antibiotic trials for the treatment of mild to moderate chronic obstructive pulmonary disease exacerbations. We compared the numbers of patients recruited in placebo-controlled and head-to-head trials between 1957 and 2005. Using cumulative meta-analysis of placebo-controlled trials, we determined when, if ever, placebo-controlled trials had shown convincing evidence that antibiotics are effective in preventing treatment failure in patients with mild to moderate chronic obstructive pulmonary disease exacerbations.
The first head-to-head trial was published in 1963. It was followed by another 100 trials comparing different antibiotics in a total of 34,029 patients with mild to moderate chronic obstructive pulmonary disease exacerbations. Over time, the cumulative odds ratio in placebo-controlled trials remained inconclusive throughout with odds ratios ranging from 0.39 (95% confidence intervals 0.04-4.22) to the most recent estimate (1995) of 0.81 (95% confidence intervals 0.52-1.28, P = 0.37).
Placebo-controlled trials do not support the use of antibiotics in chronic obstructive pulmonary disease patients with mild to moderate exacerbations. Conducting head-to-head trials is, therefore, scientifically and ethically questionable. This underscores the requirement to perform or study systematic reviews of placebo-controlled trials before conducting head-to-head trials.
BMC Medicine 11/2008; 6(1):28. DOI:10.1186/1741-7015-6-28 · 7.25 Impact Factor
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