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Ghosh A, Chatterjee S. Comparison of Efficacy and Safety of Cefpodoxime and Amoxicillin-Clavulanate Potassium in Paediatric Acute Otitis Media in Children below Two Years: A Prospective Longitudinal Study. J Clin Diagn Res 2017; 11:FC01-FC04. [PMID: 28764189 DOI: 10.7860/jcdr/2017/25252.9955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/20/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acute Otitis Media (AOM) is one of the frequently diagnosed diseases in children below two years. Amoxicillin-clavulanate potassium is the first line drug in treatment of Paediatric AOM (PAOM). Cefpodoxime has good antimicrobial activity against various types of microorganisms that include causative microorganisms of PAOM. AIM To compare the efficacy and safety of cefpodoxime and amoxicillin-clavulanate potassium for the treatment of PAOM in children below two years. MATERIALS AND METHODS A prospective longitudinal study was conducted on children diagnosed with PAOM. Thirty-six children were included in the study: 17 in the Group A (amoxicillin-clavulanate potassium) and 19 in the Group B (cefpodoxime). Primary outcome of this study was clinical success rate at day 10 visit and secondary outcome was incidence of Adverse Events (AEs). RESULTS The clinical success rates were 93.8% in Group A and 88.2 % in Group B. These rates are comparable and no statistically significant difference was observed between the groups. Few mild and self-limiting AEs were observed and both the drugs were well tolerated. CONCLUSION The results of this prospective study showed that a 10-day course of cefpodoxime is therapeutically comparable to amoxicillin-clavulanate potassium in terms of both efficacy and safety for the treatment of PAOM in children below two years.
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Affiliation(s)
- Arijit Ghosh
- Associate Professor, Department of Pharmacology, Malda Medical College, Malda, West Bengal, India
| | - Sayan Chatterjee
- Assistant Professor, Department of Paediatrics, Malda Medical College, Malda, West Bengal, India
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Transcutaneous Immunization with a Band-Aid Prevents Experimental Otitis Media in a Polymicrobial Model. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00563-16. [PMID: 28381402 DOI: 10.1128/cvi.00563-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/27/2017] [Indexed: 11/20/2022]
Abstract
Otitis media (OM) is a common pediatric disease, and nontypeable Haemophilus influenzae (NTHI) is the predominant pathogen in chronic OM, recurrent OM, and OM associated with treatment failure. OM is also a polymicrobial disease, wherein an upper respiratory tract viral infection predisposes to ascension of NTHI from the nasopharynx, the site of colonization, to the normally sterile middle ear, resulting in disease. Using a clinically relevant viral-bacterial coinfection model of NTHI-induced OM, we performed transcutaneous immunization (TCI) via a band-aid delivery system to administer each of three promising NTHI vaccine candidates derived from bacterial adhesive proteins and biofilm mediators: recombinant soluble PilA (rsPilA), chimV4, and integration host factor. Each immunogen was admixed with the adjuvant LT(R192G/L211A), a double mutant of Escherichia coli heat-labile enterotoxin, and assessed for relative ability to prevent the onset of experimental OM. For each cohort, the presence of circulating immunogen-specific antibody-secreting cells and serum antibody was confirmed prior to intranasal NTHI challenge. After bacterial challenge, blinded video otoscopy and tympanometry revealed a significant reduction in the proportion of animals with signs of OM compared to levels in animals receiving adjuvant only, with an overall vaccine efficacy of 64 to 77%. These data are the first to demonstrate the efficacy afforded by TCI with a band-aid vaccine delivery system in a clinically relevant polymicrobial model of OM. The simplicity of TCI with a band-aid and the significant efficacy observed here hold great promise for reducing the global burden of OM in the pediatric population.
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103
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Ababneh MA, Al-Azzam SI, Ababneh R, Rababa'h AM, Demour SA. Antibiotic prescribing for acute respiratory infections in children in Jordan. Int Health 2017; 9:124-130. [PMID: 28338813 DOI: 10.1093/inthealth/ihx003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Most acute respiratory infections (ARIs) in children are due to viral etiology; however, over-prescribing of antibiotics for ARIs is common. The aim of this investigation was to identify antibiotic prescribing prevalence for children with ARIs and to identify predictors of broad-spectrum antibiotic prescribing. Methods This was a prospective cross sectional study in a sample of ambulatory care settings in Jordan. Children (<18 years) presenting with ARIs were assessed in terms of patient's demographics, antibiotic prescription and clinical diagnosis. Multivariable logistic regression analysis was used to identify predictors of broad-spectrum antibiotic prescription. Results Antibiotics were prescribed for 78.4% (4575/5829) of children with ARIs. Antibiotic prescription for ARIs for which antibiotics are not indicated was 69.2% (2688/3883). Broad-spectrum antibiotic prescription occurred in 51.1% (2337/4575) of all antibiotic-prescribed participants. Some of the predictors of broad-spectrum antibiotic prescription were: otitis media (OR 4.93 [95% CI 3.44-7.14]), tonsillitis (OR 6.03 [95% CI 4.39-8.33]), age 0-5 years (OR 1.17 [95% CI 1.02-1.38]) compared to age 6-12 years, fever (OR 2.14 [95% CI 1.78-2.59]), outpatient setting (OR 73 [95% CI 2.17-3.42]) and military sector (OR 2.29 [95% CI 1.82-2.90]). Conclusions Antibiotic prescribing is high and often inappropriate. Predictors of broad-spectrum antibiotic prescribing were identified. Health policy initiatives should involve all stakeholders to minimize inappropriate antibiotic prescription and to prevent poor outcomes associated with such practice.
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Affiliation(s)
- Mera A Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110Jordan
| | - Sayer I Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110Jordan
| | - Rawan Ababneh
- Department of Clinical Pharmacy, Royal Medical Services, Amman, Jordan
| | - Abeer M Rababa'h
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110Jordan
| | - Saddam Al Demour
- Department of Special Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan
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The use of practice guidelines in the management of pediatric cases of Acute Otitis Media in Amman, Jordan. Int J Pediatr Otorhinolaryngol 2017; 96:39-46. [PMID: 28390611 DOI: 10.1016/j.ijporl.2017.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The widespread emergence of antimicrobial resistance has led many healthcare institutions to adopt more conservative antibiotic prescription practice guidelines for the treatment of acute otitis media (AOM). Little is known about the awareness and use of such guidelines by physicians in Jordan. Our aim was to pilot an anonymous survey instrument that would assess AOM treatment trends as well as awareness of and adherence to practice guidelines in Amman. By qualitatively assessing the management of AOM we could illuminate possible disparities in treatment trends, evaluate variability in practice guideline adherence, and help focus efforts of future educational programs that pertain to pediatric AOM management. METHODS A total of 71 practicing physicians were anonymously surveyed in Amman, Jordan. The survey assessed awareness of and adherence to practice guidelines by prompting responses to hypothetical AOM cases. Differences in performance between various physician groups were noted. RESULTS In total, participants answered 61.2% of the questions correctly. It was found that trainees would prescribe more appropriate antibiotics relative to attending physicians (p = 0.008). It was found that medical physicians followed guidelines more appropriately relative to ENT surgeons (64.2% of questions answered correctly vs. 58.1% of questions answered correctly; p = 0.015) and that physicians who report adhering to guidelines all/most of the time followed guidelines more appropriately relative to those who report adhering only sometimes or never (64.0% of questions answered correctly vs. 58.0% of questions answered correctly; p = 0.011). Also, cases that dealt with children were the most difficult for participants to diagnose as compared with cases that dealt with adults. CONCLUSION We conducted the first known qualitative analysis of otitis media practices in Amman and found numerous shortcomings in AOM guideline familiarity. Awareness of practice guidelines can lead to more appropriate AOM management, but there is variability between groups in guideline familiarity and utilization. Interventions that promote more conservative antibiotic prescriptions could be targeted towards groups that prescribe antibiotics less appropriately relative to their colleagues e.g. attending physicians and ENT surgeons. Interventions could also target physicians who manage pediatric AOM cases as participants had the most difficulty in properly diagnosing cases that involved children and infants.
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105
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Sun D, McCarthy TJ, Liberman DB. Cost-Effectiveness of Watchful Waiting in Acute Otitis Media. Pediatrics 2017; 139:peds.2016-3086. [PMID: 28258074 DOI: 10.1542/peds.2016-3086] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND American Academy of Pediatrics guidelines for acute otitis media (AOM) allow for children meeting certain criteria to undergo watchful waiting (WW). The cost-effectiveness of this policy has not been evaluated in the United States. METHODS A retrospective review of a random selection of 250 patients ≤18 years old with AOM in the emergency department of a tertiary care children's hospital was used to characterize current practice of AOM management. These data were incorporated into a decision-analytic cost-utility model comparing the cost-effectiveness of implementing WW to current practice. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed in 2015 USD per disability-adjusted life year (DALY) averted from a societal perspective. Multiple sensitivity analyses were conducted. RESULTS From this cohort, chart review confirmed 247 actually had AOM on physical examination. Of these, 231 (93.5%) were prescribed antibiotics, 7 (2.8%) underwent WW, and 9 (3.6%) were sent home without an antibiotic prescription. When American Academy of Pediatrics criteria for WW were applied to this population, 104 patients (42.1%) met conditions for immediate antibiotic prescription, and 143 patients (57.9%) qualified for WW. In our modeled scenario, for every 1000 patients with AOM, implementing WW yielded 514 fewer immediate antibiotic prescriptions and 205 fewer antibiotic prescriptions used, averting 14.3 DALYs, and saving $5573. The preferability of WW over current practice proved highly robust to sensitivity analysis. CONCLUSIONS WW for AOM management is cost-effective. Implementing WW may improve outcomes and reduce health care expenditures.
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Affiliation(s)
- Di Sun
- Department of Pediatrics, and
| | - T J McCarthy
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California; and
| | - Danica B Liberman
- Department of Pediatrics, and .,Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, California.,Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Adherence to acute otitis media diagnosis and treatment guidelines among Israeli otolaryngologists. Int J Pediatr Otorhinolaryngol 2017; 95:63-68. [PMID: 28576535 DOI: 10.1016/j.ijporl.2017.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The recent Israeli acute otitis media (AOM) guidelines, drafted mainly by pediatricians and family physicians in 2013, addressed diagnostic and therapeutic issues, in order to reduce over-diagnosis and treatment. These guidelines are considered as the 'standard of care' for AOM management. While the adherence rate of pediatricians to previous Israeli AOM guidelines (2004) was reported to be high (>85%), the compliance of otolaryngologists has not been studied. METHODS An anonymous 19-item questionnaire was circulated among practicing Israeli otolaryngologists (residents [n = 93], specialists [n = 283]). All the items were scored according to the number of correct answers in line with the guidelines, and summed on a 0-100 scale. RESULTS Response rate was 34% (n = 127). Overall, scores of correct answers of residents (n = 48, 52% of all residents) and specialists (n = 79, 28% of all specialists) were similar, and showed comparable moderate adherence to both guidelines: 55.7 vs 58.3 (p = 0.26). Residents were more likely to adhere to the U.S. guidelines, when compared to specialists (score difference 6.1 vs 2.8, p = 0.008). Responders preferred the microscope for diagnosis (48%), over the recommended (pneumatic) otoscope (62%) (p = 0.05), and were more likely to start antibiotic therapy (62%), rather than the 'watchful waiting' (38%) (p = 0.03). Concerning antibiotic treatment, 50% of otolaryngologists prescribed amoxicillin as recommended, at 60-80 mg/kg/d. CONCLUSION The moderate adherence rate suggests that the guidelines were partially adopted by otolaryngologists, who use different instrumentation than recommended, and treat more severe/complicated cases. Over-treatment with antibiotics and inaccurate dosing regimens are still common. Better implementation of the AOM guidelines among otolaryngologists should be performed in designated training platforms.
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107
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Tawfik KO, Ishman SL, Altaye M, Meinzen-Derr J, Choo DI. Pediatric Acute Otitis Media in the Era of Pneumococcal Vaccination. Otolaryngol Head Neck Surg 2017; 156:938-945. [DOI: 10.1177/0194599817699599] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives (1) Describe longitudinal trends in annual prevalence of hospital admission for pediatric acute otitis media (AOM) and complications of AOM (CAOM) since introduction of pneumococcal vaccination in 2000 and (2) describe the longitudinal trend of prevalence of hospital admission for pneumococcal meningitis in children with AOM-related diagnoses in the postvaccination era. Study Design Retrospective analysis of Kids’ Inpatient Database from 2000 to 2012. Setting Community, nonrehabilitation hospitals. Subjects and Methods To determine annual prevalence of admission for AOM/CAOM, nationally weighted frequencies of children aged <21 years with acute suppurative otitis media, acute mastoiditis, suppurative labyrinthitis, and/or acute petrositis were collected. The frequency of coexisting pneumococcal meningitis diagnoses among these patients was also collected. Trend analysis of prevalences of admission for AOM/CAOM and for pneumococcal meningitis occurring in the setting of AOM/CAOM from 2000 to 2012 was performed. Results Between 2000 and 2012, annual prevalence of admission for AOM/CAOM decreased from 3.956 to 2.618 per 100,000 persons ( P < .0001) (relative risk reduction 34%). Declines in admission prevalence were most pronounced in children <1 year of age (from 22.647 to 8.715 per 100,000 persons between 2000 and 2012, P < .0001) and 1 to 2 years of age (from 13.652 to 5.554 per 100,000 persons between 2000 and 2012, P < .0001). For all ages, the admission prevalence for pneumococcal meningitis and concomitant AOM/CAOM decreased (from 1.760 to 0.717 per 1,000,000 persons, P < .0001) over the study period. Conclusions The prevalence of hospital admission for pediatric AOM/CAOM has declined since the advent of pneumococcal vaccination. Admission rates for pneumococcal meningitis with AOM/CAOM have similarly declined.
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Affiliation(s)
- Kareem O. Tawfik
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stacey L. Ishman
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Divisions of Otolaryngology–Head & Neck Surgery and Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jareen Meinzen-Derr
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Otolaryngology–Head & Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel I. Choo
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Otolaryngology–Head & Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Ilechukwu GC, Ilechukwu CA, Ubesie AC, Okoroafor I, Ezeanolue BC, Ojinnaka NC. Bacterial agents of the discharging middle ear among children seen at the University of Nigeria Teaching Hospital, Enugu. Pan Afr Med J 2017; 26:87. [PMID: 28491218 PMCID: PMC5410015 DOI: 10.11604/pamj.2017.26.87.9243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/20/2016] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Discharging middle ear continues to be one of the commonest problems seen in the developing world. There is an ever growing need to carry out studies periodically to determine the common bacterial agents responsible for discharging otitis media and their antibiotic sensitivity especially in set-ups characterized with minimal laboratory services. The study sought to determine the common bacterial agents causing discharging middle ear among children presenting at the University of Nigeria Teaching Hospital, Enugu and their sensitivity to the commonly available antibiotics. METHODS Middle ear swabs were collected from 100 children aged 1 month to 17 years at the Children Out-Patient and Otorhinolaryngology Clinics of the University of Nigeria Teaching Hospital, Enugu, Nigeria. The specimens were cultured for aerobic bacterial organisms and their sensitivity determined. RESULTS Among those with acute discharge, Staphylococcal aureus was isolated in 31.3% and Proteus species in 25.0%. In chronically discharging ears, Proteus Species dominated (39.1%), followed by Staphylococcal aureus (28.3%). CONCLUSION Staphylococcal aureus and Proteus species were the commonest bacterial agents in acute and chronic otitis media respectively. Most isolates showed high sensitivity to the fluoroquinolone antibiotics.
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Affiliation(s)
| | | | | | - Ijeoma Okoroafor
- Department of Otorhinolaryngology, University of Nigeria/University of Nigeria Teaching Hospital, Enugu
| | | | - Ngozi Chinyelu Ojinnaka
- Department of Paediatrics, University of Nigeria, University of Nigeria Teaching Hospital, Enugu
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Simon AE, Boss EF, Zelaya CE, Hoffman HJ. Racial and Ethnic Differences in Receipt of Pressure Equalization Tubes Among US Children, 2014. Acad Pediatr 2017; 17:88-94. [PMID: 27422495 PMCID: PMC5167642 DOI: 10.1016/j.acap.2016.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/27/2016] [Accepted: 07/03/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Pressure equalization tube (PET) placement (also referred to as tympanostomy tube placement) is among the most common ambulatory surgical procedures performed on US children. More than 20 years ago, differences according to race/ethnicity in the national prevalence of having had PETs placed were documented. Whether these differences persist is unknown. METHODS We used data from the 2014 National Health Interview Survey to examine the percentage of children 0 to 17 years of age who have ever undergone PET placement. Unadjusted logistic regression with predictive margins was used to assess the relationship between having received PETs and race/ethnicity, as well as other clinical, socioeconomic, and geographic factors. Multivariable logistic regression was used to determine whether other factors could account for any observed differences according to race/ethnicity. RESULTS Overall, 8.9% of children 0 to 17 years of age had undergone PET surgery. By race/ethnicity, 12.6% of non-Hispanic white children received PETs, which was significantly greater than the 4.8% of non-Hispanic black, 4.4% of Hispanic, and 5.6% of non-Hispanic other/multiple race children who had this surgery (P < .001 for all comparisons). In multivariable analysis, the adjusted prevalence for non-Hispanic white children (10.8%) was greater than for non-Hispanic black (5.4%) and Hispanic (5.8%) children (P < .001 for both comparisons). CONCLUSIONS Nearly 9% of US children have had PETs placed. Non-Hispanic white children still have a greater prevalence of PET placement compared with non-Hispanic black and Hispanic children. These differences could not be fully explained by other demographic, clinical, socioeconomic, or geographic differences between racial/ethnic groups.
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Affiliation(s)
- Alan E Simon
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md.
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Carla E Zelaya
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md
| | - Howard J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Md
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110
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Otitis, Sinusitis and Related Conditions. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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111
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Bedard N, Shope T, Hoberman A, Haralam MA, Shaikh N, Kovačević J, Balram N, Tošić I. Light field otoscope design for 3D in vivo imaging of the middle ear. BIOMEDICAL OPTICS EXPRESS 2017; 8:260-272. [PMID: 28101416 PMCID: PMC5231297 DOI: 10.1364/boe.8.000260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 05/26/2023]
Abstract
We present a light field digital otoscope designed to measure three-dimensional shape of the tympanic membrane. This paper describes the optical and anatomical considerations we used to develop the prototype, along with the simulation and experimental measurements of vignetting, field curvature, and lateral resolution. Using an experimental evaluation procedure, we have determined depth accuracy and depth precision of our system to be 0.05-0.07 mm and 0.21-0.44 mm, respectively. To demonstrate the application of our light field otoscope, we present the first three-dimensional reconstructions of tympanic membranes in normal and otitis media conditions, acquired from children who participated in a feasibility study at the Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center.
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Affiliation(s)
- Noah Bedard
- Ricoh Innovations Corporation, Cupertino, CA 95014,
USA
| | - Timothy Shope
- Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213,
USA
| | - Alejandro Hoberman
- Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213,
USA
| | - Mary Ann Haralam
- Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213,
USA
| | - Nader Shaikh
- Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213,
USA
| | - Jelena Kovačević
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA 15213,
USA
| | - Nikhil Balram
- Ricoh Innovations Corporation, Cupertino, CA 95014,
USA
| | - Ivana Tošić
- Ricoh Innovations Corporation, Cupertino, CA 95014,
USA
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Han SB, Kim JH, Kang JH, Ma SH, Kim CS, Kim KH, Kim HM, Choi YY. Recent epidemiology of Streptococcus pneumoniae in nasopharynxes of Korean children with acute otitis media. J Infect Chemother 2016; 23:136-141. [PMID: 28024738 DOI: 10.1016/j.jiac.2016.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/18/2016] [Accepted: 10/22/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND This prospective study was performed to evaluate serotype distribution, multilocus sequence typing, and antibiotic susceptibility of Streptococcus pneumoniae identified in Korean children with acute otitis media (AOM) after the introduction of a 7-valent pneumococcal conjugate vaccine (PCV7). METHODS Nasopharyngeal aspirates were collected from children diagnosed with AOM in seven hospitals in Korea. The bacteria identified in these samples and the serotypes, sequence types (STs), and antibiotic susceptibilities of S. pneumoniae isolates were evaluated. RESULTS A total of 390 children were enrolled, and bacteria were identified in 376 (96.4%) children. S. pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were identified in 155 (39.7%), 127 (32.6%) and 86 (22.1%) children, respectively. Serotype 19A (22.4%) was the most common S. pneumoniae serotype, with serogroups 11 (14.7%) and 15 (13.5%) following. ST320 (23.5%) was the most common ST; ST166 (17.0%) and ST83 (8.5%) followed. The overall susceptibility rates of S. pneumoniae to oral penicillin V and amoxicillin/clavulanate were 2.6% and 53.2%, respectively. The susceptibility rate to cefditoren was 91.0%; however, the rates for other cephalosporins were less than 10.0%. Compared with other serogroups, S. pneumoniae serogroups 19, 11, and 15 showed significantly lower susceptibility rates to all the antibiotics tested. CONCLUSION S. pneumoniae serotype 19A, serogroups 11 and 15 were the major nasopharyngeal-colonizing bacteria in Korean children with AOM after the introduction of PCV7. These relatively prevalent serotype/serogroups showed lower antibiotic susceptibility rates.
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Affiliation(s)
- Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Sang Hyuk Ma
- Department of Pediatrics, Fatima Hospital, Changwon, Republic of Korea
| | - Chun Soo Kim
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Kyung-Hyo Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Center for Vaccine Evaluation and Study, Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Hwang Min Kim
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Youn Choi
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea
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Rosenfeld RM, Shiffman RN. Clinical Practice Guidelines: A Manual for Developing Evidence-Based Guidelines to Facilitate Performance Measurement and Quality Improvement. Otolaryngol Head Neck Surg 2016. [DOI: 10.1016/j.otohns.2006.06.1277] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Richard M. Rosenfeld
- From: SUNY Downstate Medical Center and the Long Island College Hospital, Brooklyn, NY;
| | - Richard N. Shiffman
- Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut
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Di Pierro F, Zanvit A, Colombo M. Role of a proprietary propolis-based product on the wait-and-see approach in acute otitis media and in preventing evolution to tracheitis, bronchitis, or rhinosinusitis from nonstreptococcal pharyngitis. Int J Gen Med 2016; 9:409-414. [PMID: 27956842 PMCID: PMC5113938 DOI: 10.2147/ijgm.s118967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Antipyretics and/or anti-inflammatory drugs along with a wait-and-see approach are the only treatments recommended in early acute otitis media (AOM) or viral pharyngitis. Propolis has been widely investigated for its antibacterial, antiviral, and anti-inflammatory properties and could perhaps be administered as an add-on therapy during watchful waiting in AOM or for better control of symptoms in nonstreptococcal pharyngitis. However, propolis has well-known problems of poor solubility and low oral bioavailability. We therefore analyzed a proprietary propolis-based product (Propolisina®) developed to overcome these limitations, in a retrospective, open-label, controlled study of Streptococcus pyogenes-negative children with a diagnosis of AOM or pharyngitis. Our results show that the use of propolis supplement for 72 hours lessens the severity of AOM and viral pharyngitis, reduces the use of antipyretics and anti-inflammatory drugs, and decreases the rate of evolution to tracheitis, bronchitis, and rhinosinusitis. Our study shows that propolis could be used as a safe add-on therapy in case of AOM and/or viral pharyngitis.
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Affiliation(s)
| | - Alberto Zanvit
- Biological Dentistry Department, Italian Stomatology Institute
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115
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Abstract
La otitis media aguda es una patología infecciosa del oído medio muy frecuente. El diagnóstico es clínico, por lo que es fundamental un acucioso examen físico y una neumootoscopía para evaluar la movilidad timpánica. Hay dos tendencias respecto al manejo, tratamiento antibiótico inmediato u observación estricta (dependiendo de las características del paciente y del cuadro clínico). Los gérmenes más frecuentes son los virus, Neumococo, Haemophilus influenza y Moraxella catarrhalis. La prevalencia de cada uno de ellos varía según región geográfica y según la presencia de vacunación. La resistencia a antibióticos ha ido en aumento en estos años, pero aún puede considerarse sensible a amoxicilina por lo que se recomienda su uso como primera línea. En el caso de fracaso a tratamiento pueden utilizarse asociaciones con B-lactámicos y/o cefalosporinas, dejando en forma excepcional clindamicina o quinolonas. Aquellos niños con OMA recurrente requerirán evaluación por especialidad para mayor estudio y tratamiento.
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116
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Ghadersohi S, Young NM, Smith-Bronstein V, Hoff S, Billings KR. Management of acute complicated mastoiditis at an urban, tertiary care pediatric hospital. Laryngoscope 2016; 127:2321-2327. [PMID: 27796038 DOI: 10.1002/lary.26365] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/31/2016] [Accepted: 09/09/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the presentation and management of acute complicated mastoiditis in children. STUDY DESIGN Retrospective case series. METHODS An analysis of pediatric patients with acute complicated mastoiditis treated at an urban, tertiary care children's hospital from 2007 to 2014 was performed. RESULTS Forty-eight patients presented with a total of 67 complications of acute mastoiditis. Mean age at presentation was 4.8 years (range = 0.1-15.3 years). The most common complications were subperiosteal abscess (n = 22, 45.8%), epidural abscess (n = 16, 33.3%), and sigmoid sinus thrombosis (n = 14, 29.2%). The most common pathogens isolated included Streptococcus pneumoniae (n = 14, 29.2%) and group A streptococcus (n = 10, 20.8%). Multidrug resistance was not associated with complication type. Surgical management included myringotomy ± tympanostomy tube placement in 46 (95.8%) patients (the only surgery in 10), drainage of subperiosteal abscess without mastoidectomy in 18 (37.5%) patients, and mastoidectomy in 21 (43.8%) total patients. Patients presenting with intracranial complications were the most likely to undergo a mastoidectomy. Anticoagulation was used in the management of nine of 14 (64.3%) patients presenting with sigmoid sinus thrombosis. Neurosurgical interventions (n = 7, 14.6% patients) were primarily performed to manage increased intracranial pressure. CONCLUSIONS Subperiosteal abscess was the most common complication of acute mastoiditis, and when occurring as the sole complication was successfully managed with antibiotics and surgical intervention that did not include mastoidectomy. Epidural abscess and sigmoid sinus thrombosis were more prevalent than reported in prior series and were managed more aggressively. These patients were more likely to need neurosurgical interventions. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2321-2327, 2017.
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Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Nancy M Young
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Virginia Smith-Bronstein
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Stephen Hoff
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Kathleen R Billings
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
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Ference EH, Min JY, Chandra RK, Schroeder JW, Ciolino JD, Yang A, Holl J, Shintani Smith S. Antibiotic Prescribing by Physicians Versus Nurse Practitioners for Pediatric Upper Respiratory Infections. Ann Otol Rhinol Laryngol 2016; 125:982-991. [DOI: 10.1177/0003489416668193] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: This study investigates differences in antibiotic prescribing rates for pediatric upper respiratory infections (URIs) between physicians and nurse practitioners (NPs). Methods: Visits by children <18 years old diagnosed with URI to physicians or NPs between 2001 and 2010 were abstracted from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey. Logistic regression analyses examined variations in antibiotic prescribing rates. Results: Upper respiratory infections accounted for approximately 439 ± 21.5 million visits. Patients seen by NPs were more likely to have Medicaid, live in the lowest median household income quartile zip codes and micropolitan locations, and live in the South compared to patients seen by physicians. Nurse practitioners prescribed antibiotics 66.7% ± 4.2% of the time versus physicians at 52.8% ± 0.8% for URI visits (unadjusted P-value = .002). Adjusted by specialty, URI type, and chronic diseases, NPs had marginally significantly different odds of prescribing antibiotics (OR = 1.6, 95% CI, 1.0-2.6, P-value = .048), but the association with prescribing broad-spectrum antibiotics is not as strong (adjusted P-value = .063). Patient visits to a pediatric (OR = 0.54, 95% CI, 0.43-0.67) or ENT/surgery practice (OR = 0.11, 95% CI, 0.06-0.18) had lower odds of antibiotic prescribing compared to general/family medicine practices. Year (2001-2010) was not significantly associated with antibiotic or broad-spectrum antibiotic prescribing rates for physicians, but rates for NPs fell for otitis media ( P-value = .007) from 90.2% ± 8.2% (2001-2002) to 74.8% ± 6.8% (2009-2010) of visits. Conclusions: Nurse practitioners have higher rates of antibiotic prescribing compared to physicians for pediatric patients with URIs; however, this difference is less after adjusting for specialty. Examining comparative antibiotic prescribing is important to promote evidence-based practice and adoption of clinical guidelines.
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Affiliation(s)
- Elisabeth H. Ference
- Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jin-Young Min
- Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rakesh K. Chandra
- Vanderbilt Department of Otolaryngology, Bill Wilkerson Center, Nashville, Tennesse, USA
| | - James W. Schroeder
- Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois, USA
| | - Jody D. Ciolino
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Yang
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane Holl
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Pediatrics-Community Based Primary Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephanie Shintani Smith
- Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Pichichero ME, Almudevar A. Inflammation-associated cytokine analysis identifies presence of respiratory bacterial pathogens in the nasopharynx. Pathog Dis 2016; 74:ftw064. [PMID: 27493063 DOI: 10.1093/femspd/ftw064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 11/12/2022] Open
Abstract
We sought to determine if inflammatory cytokines are induced during asymptomatic nasopharyngeal (NP) colonization by the common respiratory bacteria Streptococcus pneumoniae (Spn), non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat). 85 serum samples were studied from 85 children 6-36 months of age when children were healthy and potentially NP colonized with Spn, NTHi or Mcat. Immunoassays were used to quantitate serum sICAM-1, IL-10 and S100A12 levels. Logistic regression was used to develop a predictive model for NP colonization probability for causative bacterial pathogen presence. Serum levels of sICAM-1, IL-10 and S100A12 increased during asymptomatic NP colonization by Spn, NTHi and Mcat. In a statistical model using risk scoring, we found high positive predictive and negative value, sensitivity and specificity when using these three cytokines to identify the presence of Spn, NTHi and Mcat in the NP. For the first time, we show that inflammatory cytokines are induced in serum during asymptomatic NP colonization by Spn, NTHi and Mcat.
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Affiliation(s)
- Michael E Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY 14621, USA
| | - Anthony Almudevar
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY 14621, USA
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Marchisio P, Pipolo C, Landi M, Consonni D, Mansi N, Di Mauro G, Salvatici E, Di Pietro P, Esposito S, Felisati G, Principi N. Cerumen: A fundamental but neglected problem by pediatricians. Int J Pediatr Otorhinolaryngol 2016; 87:55-60. [PMID: 27368443 DOI: 10.1016/j.ijporl.2016.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Under physiological conditions, cerumen (Ce) is regularly extruded from the ear canal by a self-cleaning mechanism. Failure of this mechanism leads to excessive accumulation or impaction of Ce. Limited data are available concerning the prevalence of cerumen in healthy and sick infants and children. We assessed the prevalence of Ce in a large population of infants and children and compared the Ce removal attitudes of paediatricians (PEDs) and otorhinolaryngologists (ENTs). METHODS Children seen in November 2014 for acute respiratory infections, including suspected acute otitis media, or well-being visits, were enrolled. The following data were recorded: presence, laterality, and amount of Ce; presenting complaints and final diagnosis; attempt to remove Ce during the visit; and type of physician. RESULTS Among 819 children aged 1 month to 12 years, Ce was present in 594 (72.5%), of whom 478 (80.5%) had bilateral Ce, and 261 (43.9%) had Ce in a relevant amount (cerumen obstructing at least 50% of the ear canal). Presence of Ce was more common in younger and in African or Asian children. PEDs were less likely to remove cerumen than ENTs (28.8% vs 91.0%, p < 0.001) irrespective of age, gender, race and reason for visit. Ce was removed by PEDs in less than one-third of sick children with a final diagnosis of acute otitis media (AOM) (31.6%) compared with almost all the children by ENTs (95.6%, p < 0.001). CONCLUSION Ce is highly prevalent in healthy and sick children but is quite neglected by PEDs. Educational programs to reinforce the importance of Ce removal and to improve the techniques for removal in case of suspected AOM should be implemented and rigorously evaluated in order to avoid incorrect diagnosis and erroneous treatments.
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Affiliation(s)
- Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Carlotta Pipolo
- Otolaryngology-Head and Neck Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Mansi
- Department of Otolaryngology, Ospedale Santobono Pausilipon, Naples, Italy
| | | | - Elisabetta Salvatici
- Department of Pediatrics, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology-Head and Neck Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Heidemann CH, Lous J, Berg J, Christensen JJ, Håkonsen SJ, Jakobsen M, Johansen CJ, Nielsen LH, Hansen MP, Poulsen A, Schousboe LP, Skrubbeltrang C, Vind AB, Homøe P. Danish guidelines on management of otitis media in preschool children. Int J Pediatr Otorhinolaryngol 2016; 87:154-63. [PMID: 27368465 DOI: 10.1016/j.ijporl.2016.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Otitis media is one of the most common diseases in small children. This underlines the importance of optimizing diagnostics and treatment of the condition. Recent literature points toward a stricter approach to diagnosing acute otitis media (AOM). Moreover, ventilating tube treatment for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) has become the most frequently performed surgical procedure in pre-school children. Therefore, the Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology, Head and Neck Surgery deemed it necessary to update the Danish guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of RAOM and COME. METHODS The GRADE system (The Grading of Recommendations Assessment, Development and Evaluation) was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted between July and December 2014. The quality of the existing literature was assessed using AGREE II (Appraisal of Guidelines for Research & Evaluation), AMSTAR (assessing the Methodological Quality of Systematic Reviews), QUADAS-2 (Quality of Diagnostic Accuracy Studies), Cochrane Risk of Bias Tool for randomized trials and ACROBAT-NRSI (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies). The working group consisted of otolaryngologists, general practitioners, pediatricians, microbiologists and epidemiologists. CONCLUSION Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline.
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Affiliation(s)
- C H Heidemann
- Danish Health and Medicines Authority, Denmark; Department of ENT - Head & Neck Surgery, Odense University Hospital, Denmark; Department of Otorhinolaryngology, Vejle Hospital, Denmark.
| | - J Lous
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Denmark
| | - J Berg
- ENT Private Clinic, Århus, Denmark
| | - J J Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Denmark
| | - S J Håkonsen
- Danish Health and Medicines Authority, Denmark; Centre for Clinical Guidelines, Department of Health Science and Technology, University of Aalborg, Denmark
| | - M Jakobsen
- Danish Health and Medicines Authority, Denmark
| | | | - L H Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Denmark
| | - M P Hansen
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Denmark; Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - A Poulsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Denmark
| | - L P Schousboe
- Department of Otorhinolaryngology, Vejle Hospital, Denmark
| | - C Skrubbeltrang
- Danish Health and Medicines Authority, Denmark; Medical Library, Aalborg University Hospital, Denmark
| | - A B Vind
- Danish Health and Medicines Authority, Denmark
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Denmark
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121
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Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: A meta-analysis. Otolaryngol Head Neck Surg 2016; 136:340-7. [PMID: 17321857 DOI: 10.1016/j.otohns.2006.10.007] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 10/05/2006] [Indexed: 11/20/2022]
Abstract
Background Recent analysis of clinical data and a clearer understanding of the role of chemical structure in the development of cross-reactivity indicate that the increased risk of an allergic reaction to a cephalosporin in penicillin-allergic patients is smaller than previously postulated. Method Medline and EMBASE databases were searched with the keywords: cephalosporin, penicillin, allergy, and crosssensitivity for the years 1960 through 2005. Among 219 articles retrieved, 9 served as source material for this evidence-based meta-analysis. Results A significant increase in allergic reactions to cephalothin (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.1 to 5.5), cephaloridine (OR = 8.7; CI = 5.9 to 12.8), and cephalexin (OR = 5.8; CI = 3.6 to 9.2), and all first generation cephalosporins plus cefamandole (OR = 4.8; CI = 3.7 to 6.2) were observed in penicillin allergic patients; no increase was observed with second generation cephalosporins (OR = 1.1; CI, 0.6 to 2.1) or third generation cephalosporins (OR = 0.5; CI = 0.2 to 1.1). Clinical challenges, skin testing, and monoclonal antibody studies point to the paramount importance of similarities in side chain structure to predict cross-allergy between cephalosporins and penicillins. Conclusion First-generation cephalosporins have cross-allergy with penicillins, but cross-allergy is negligible with second-and third-generation cephalosporins. Particular emphasis should be placed on the role of chemical structure in determining the risk of cross-reactivity between specific agents. 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Affiliation(s)
- Michael E Pichichero
- Department of Microbiology and Immunology, University of Rochester, Elmwood Pediatric Group, Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA.
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122
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Broides A, Bereza O, Lavi-Givon N, Fruchtman Y, Gazala E, Leibovitz E. Parental acceptability of the watchful waiting approach in pediatric acute otitis media. World J Clin Pediatr 2016; 5:198-205. [PMID: 27170930 PMCID: PMC4857233 DOI: 10.5409/wjcp.v5.i2.198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/01/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine parental knowledge about acute otitis media (AOM) and its antibiotic therapy, antibiotic resistance and the willingness to comply with the watchful waiting (WW) approach in primary care settings in southern Israel.
METHODS: The study was conducted in 3 primary care clinics and the pediatric emergency room of Soroka University Medical Center. Questionnaires (20 questions on education background, previous AOM experience, knowledge on antimicrobial resistance and attitude vs the WW approach) were filled by 600 parents (150 at each centers) of children < 6 years of age.
RESULTS: Mothers represented 69% of parents; 2% had an education of < 10 school years, 46% had high-school education and 17% had an academic degree. 69% parents reported previous experience with AOM and 56% thought that antibiotics represent the only treatment for AOM. Knowledge on bacterial resistance to antibiotics was reported by 57% of the parents; 86% parents were willing to accept/probably accept the WW approach for their children. Logistic regression analysis revealed a significant association between parental education and knowledge about bacterial resistance to antibiotics and that previous experience with AOM was significantly associated with reluctance to accept the WW approach. More parents with knowledge on bacterial resistance were willing to accept the WW approach compared with parents without such knowledge. No correlation was found between the education level and willingness to accept the WW approach.
CONCLUSION: A significant correlation was found between previous parental education and experience with AOM and the knowledge about antibiotic use, bacterial resistance and acceptance of the WW approach.
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Abbott P, Gunasekera H, Leach AJ, Askew D, Walsh R, Kong K, Girosi F, Bond C, Morris P, Lujic S, Hu W, Usherwood T, Tyson S, Spurling G, Douglas M, Schubert K, Chapman S, Siddiqui N, Murray R, Rabbitt K, Porykali B, Woodall C, Newman T, Reath J. A multi-centre open-label randomised non-inferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial. Trials 2016; 17:119. [PMID: 26941013 PMCID: PMC4778283 DOI: 10.1186/s13063-016-1247-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/20/2016] [Indexed: 12/02/2022] Open
Abstract
Background Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. Methods/Design This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 − 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. Discussion The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications. Trial registration The trial is registered with Australia New Zealand Clinical Trials Registry (ACTRN12613001068752). Date of registration: 24 September 2013.
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Affiliation(s)
- Penelope Abbott
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | | | | | - Deborah Askew
- Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia. .,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Queensland Health, Brisbane, QLD, Australia.
| | - Robyn Walsh
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Kelvin Kong
- University of Newcastle, Newcastle, NSW, Australia.
| | - Federico Girosi
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Chelsea Bond
- Indigenous Studies Research Network, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Peter Morris
- Menzies School of Health Research, Darwin, NT, Australia.
| | - Sanja Lujic
- School of Medicine, Western Sydney University, Sydney, NSW, Australia. .,Centre for Big Data Research in Health, University of NSW, Sydney, NSW, Australia.
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Tim Usherwood
- Sydney Medical School Westmead, University of Sydney, Sydney, NSW, Australia.
| | - Sissy Tyson
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Queensland Health, Brisbane, QLD, Australia.
| | - Geoffrey Spurling
- Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia. .,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Queensland Health, Brisbane, QLD, Australia.
| | - Markeeta Douglas
- Awabakal Aboriginal Primary Health Care Centre, Newcastle, NSW, Australia.
| | - Kira Schubert
- Awabakal Aboriginal Primary Health Care Centre, Newcastle, NSW, Australia.
| | - Shavaun Chapman
- Winnunga Nimmityjah Aboriginal Health Service, Canberra, ACT, Australia.
| | - Nadeem Siddiqui
- Winnunga Nimmityjah Aboriginal Health Service, Canberra, ACT, Australia.
| | - Reeion Murray
- Winnunga Nimmityjah Aboriginal Health Service, Canberra, ACT, Australia.
| | - Keitha Rabbitt
- Aboriginal and Torres Strait Islander Community Health Services, Brisbane, QLD, Australia.
| | - Bobby Porykali
- Aboriginal and Torres Strait Islander Community Health Services, Brisbane, QLD, Australia.
| | - Cheryl Woodall
- Tharawal Aboriginal Corporation, Sydney, NSW, Australia.
| | - Tina Newman
- Tharawal Aboriginal Corporation, Sydney, NSW, Australia.
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
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Val S, Burgett K, Brown KJ, Preciado D. SuperSILAC Quantitative Proteome Profiling of Murine Middle Ear Epithelial Cell Remodeling with NTHi. PLoS One 2016; 11:e0148612. [PMID: 26859300 PMCID: PMC4747582 DOI: 10.1371/journal.pone.0148612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/20/2016] [Indexed: 12/12/2022] Open
Abstract
Background Chronic Otitis Media with effusion (COME) develops after sustained inflammation and is characterized by secretory middle ear epithelial metaplasia and effusion, most frequently mucoid. Non-typeable Haemophilus influenzae (NTHi), the most common acute Otitis Media (OM) pathogen, is postulated to promote middle ear epithelial remodeling in the progression of OM from acute to chronic. The goals of this study were to examine histopathological and quantitative proteomic epithelial effects of NTHi challenge in a murine middle ear epithelial cell line. Methods NTHi lysates were generated and used to stimulate murine epithelial cells (mMEEC) cultured at air-liquid interface over 48 hours– 1 week. Conditional quantitative Stable Isotope Labeling with Amino Acids in Cell Culture (SILAC) of cell lysates was performed to interrogate the global protein production in the cells, using the SuperSILAC technique. Histology of the epithelium over time was done to measure bacterial dependent remodeling. Results Mass spectrometry analysis identified 2,565 proteins across samples, of which 74 exhibited differential enrichment or depletion in cell lysates (+/-2.0 fold-change; p value<0.05). The key molecular functions regulated by NTHi lysates exposure were related to cell proliferation, death, migration, adhesion and inflammation. Finally, chronic exposure induced significant epithelial thickening of cells grown at air liquid interface. Conclusions NTHi lysates drive pathways responsible of cell remodeling in murine middle ear epithelium which likely contributes to observed epithelial hyperplasia in vitro. Further elucidation of these mediators will be critical in understanding the progression of OM from acute to chronic at the molecular level.
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Affiliation(s)
- Stéphanie Val
- Sheikh Zayed Center for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, United States of America
| | - Katelyn Burgett
- Sheikh Zayed Center for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, United States of America
| | - Kristy J. Brown
- Center for Genetic Medicine Research, Children’s National Health System, Washington, DC, United States of America
| | - Diego Preciado
- Sheikh Zayed Center for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, United States of America
- Division of Pediatric Otolaryngology, Children’s National Health System, Washington, DC, United States of America
- * E-mail:
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125
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Steele KM, Carreiro JE, Viola JH, Conte JA, Ridpath LC. Effect of osteopathic manipulative treatment on middle ear effusion following acute otitis media in young children: a pilot study. J Osteopath Med 2015; 114:436-47. [PMID: 24917631 DOI: 10.7556/jaoa.2014.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Childhood acute otitis media (AOM) is highly prevalent. Its usual sequela of middle ear effusion (MEE) can lead to conductive hearing loss, for which surgery is commonly used. OBJECTIVE To evaluate the efficacy of an osteopathic manipulative treatment (OMT) protocol on MEE resolution following an episode of AOM. The authors hypothesized that OMT provided adjunctively to standard care for young children with AOM would reduce the duration of MEE following the onset of AOM. METHODS We compared standard care only (SCO) and standard care plus OMT (SC+OMT) for the duration of MEE following AOM. Patients were aged 6 months to 2 years. The SC+OMT group received OMT during 3 weekly visits. Weekly tympanometric and acoustic reflectometer (AR) readings were obtained from all patients. RESULTS There were 52 patients enrolled, with 43 completing the study and 9 dropping out. No demographic differences were noted. Only ears from each patient with abnormal tympanograms at entry were included. There were 76 ears in the tympanogram analysis (38 from SCO; 38 from SC+OMT) and 61 ears in the AR data analysis (31 from SCO; 30 from SC+OMT). Dependence of bilateral ear disease noted in AR readings was accounted for in statistical analysis. Tympanogram data demonstrated a statistically significant improvement in MEE at visit 3 in patients in the SC+OMT group (odds ratio, 2.98; 95% confidence interval, 1.16, 7.62; χ(2) test for independence, P=.02). The AR data analysis showed statistically significant improvement at visit 3 for the SC+OMT group (z=2.05; P=.02). There was no statistically significant change in MEE before or immediately after the OMT protocol. CONCLUSION A standardized OMT protocol administered adjunctively with standard care for patients with AOM may result in faster resolution of MEE following AOM than standard treatment alone. (ClinicalTrials.gov number NCT00520039.).
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Affiliation(s)
- Karen M Steele
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
| | - Jane E Carreiro
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
| | - Judith Haug Viola
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
| | - Josephine A Conte
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
| | - Lance C Ridpath
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
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Kautz-Freimuth S, Redaèlli M, Samel C, Civello D, Altin SV, Stock S. Parental views on acute otitis media (AOM) and its therapy in children--results of an exploratory survey in German childcare facilities. BMC Pediatr 2015; 15:199. [PMID: 26620979 PMCID: PMC4666068 DOI: 10.1186/s12887-015-0516-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 11/24/2015] [Indexed: 01/08/2023] Open
Abstract
Background Acute otitis media (AOM) is one of the main reasons for medical consultation and antibiotic use during childhood. Although 80 % of AOM cases are self-limiting, antibiotic prescription is still high, either for physician- or for parent-related factors. This study aims to identify parental knowledge about, beliefs and attitudes towards, and experiences with AOM and its therapy and thus to gain insights into parents’ perspectives within the German health care system. Methods An exploratory survey was conducted among German-speaking parents of children aged 2 to 7 years who sent their children to a childcare facility. Childcare facilities were recruited by convenience sampling in different urban and rural sites in Germany, and all parents with children at those facilities were invited to participate. Data were evaluated using descriptive statistical analyses. Results One-hundred-thirty-eight parents participated. Of those, 75.4 % (n = 104) were AOM-experienced and 75.4 % (n = 104) had two or more children. Sixty-six percent generally agree that bacteria cause AOM. 20.2 % generally agree that viruses cause AOM. 30.5 % do not generally agree that viruses cause AOM. Eight percent generally agree that AOM resolves spontaneously, whereas 53.6 % do not generally agree. 92.5 % generally (45.7 %) and partly (42.8 %) agree that AOM needs antibiotic treatment. With respect to antibiotic effects, 56.6 % generally agree that antibiotics rapidly relieve earache. 60.1 % generally agree that antibiotics affect the gastrointestinal tract and 77.5 % generally agree that antibiotics possibly become ineffective after frequent use. About 40 % generally support and about 40 % generally reject a “wait-and-see” strategy for AOM treatment. Parental-reported experiences reveal that antibiotics are by far more often prescribed (70.2 %) than actively requested by parents (26.9 %). Conclusions Parental views on AOM, its therapy, and antibiotic effects reveal uncertainties especially with respect to causes, the natural course of the disease and antibiotic effects on AOM. These results indicate that more evidence-based information is needed if parents’ health literacy in the treatment of children with AOM is to be enhanced. The discrepancy between reported parental requests for antibiotics and reported actual prescriptions contradicts the hypothesis of high parental influence on antibiotic use in AOM. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0516-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sibylle Kautz-Freimuth
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany. .,Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Christina Samel
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Daniele Civello
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Sibel V Altin
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
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Kamikawa J, Granato CFH, Bellei N. Viral aetiology of common colds of outpatient children at primary care level and the use of antibiotics. Mem Inst Oswaldo Cruz 2015; 110:884-9. [PMID: 26560978 PMCID: PMC4660617 DOI: 10.1590/0074-02760150154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/22/2015] [Indexed: 11/22/2022] Open
Abstract
Although antibiotics are ineffective against viral respiratory infections, studies
have shown high rates of prescriptions worldwide. We conducted a study in Brazil to
determine the viral aetiologies of common colds in children and to describe the use
of antibiotics for these patients. Children up to 12 years with common colds were
enrolled from March 2008-February 2009 at a primary care level facility and followed
by regular telephone calls and medical consultations. A nasopharyngeal wash was
obtained at enrollment and studied by direct fluorescence assay and polymerase chain
reaction for nine different types of virus. A sample of 134 patients was obtained,
median age 2.9 years (0.1-11.2 y). Respiratory viruses were detected in 73.9%
(99/134) with a coinfection rate of 30.3% (30/99). Rhinovirus was the most frequent
virus (53/134; 39.6%), followed by influenza (33/134; 24.6%) and respiratory
syncytial virus (8/134; 13.4%). Antibiotic prescription rate was 39.6% (53/134) and
69.8% (37/53) were considered inappropriate. Patients with influenza infection
received antibiotics inappropriately in a greater proportion of cases when compared
to respiratory syncytial virus and rhinovirus infections (p = 0.016). The rate of
inappropriate use of antibiotics was very high and patients with influenza virus
infection were prescribed antibiotics inappropriately in a greater proportion of
cases.
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Affiliation(s)
- Janete Kamikawa
- Laboratório de Virologia Clínica, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Nancy Bellei
- Laboratório de Virologia Clínica, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Shie CK, Chang HT, Fan FC, Chen CJ, Fang TY, Wang PC. A hybrid feature-based segmentation and classification system for the computer aided self-diagnosis of otitis media. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:4655-8. [PMID: 25571030 DOI: 10.1109/embc.2014.6944662] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We propose a novel hybrid otitis media (OM) computer aided detection (CAD) system, designed to aid in the self-diagnosis of various forms of OM. OM is a prevalent disease in both children and adults. Our system is able to differentiate normal ear from acute otitis media (AOM), otitis media with effusion (OME) and the multi-categories of chronic otitis media including perforation, retraction, cholesteatoma, etc. We propose a modified double active contour segmentation method designed for use with otoscope images, and enabled to handle user acquired data. To describe the visual symptoms (e.g., red, bulging, effusion, perforation, retraction, etc.) of otitis media accurately, we extract color, geometric and texture features by grid color moment, Gabor filter, local binary pattern and histogram of oriented gradients. A powerful classification structure based on Adaboost is used to select the most useful features and build a strong classifier. Our system achieves classification accuracy as high as 88.06% and is suitable for real use. In addition, some interesting observations about OM otoscope images are also discussed.
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129
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Impact of Staphylococcus epidermidis lysates on middle ear epithelial proinflammatory and mucogenic response. J Investig Med 2015; 63:258-66. [PMID: 25503091 DOI: 10.1097/jim.0000000000000127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic otitis media with effusion (COME) develops after sustained inflammation and is characterized by secretory middle ear epithelial metaplasia and effusion, most frequently mucoid. Staphylococcus epidermidis, typically considered a commensal organism, is very frequently recovered in chronic middle ear fluid and in middle ear biofilms. Although it has been shown to drive inflammation in sinonasal epithelium, the impact of S. epidermidis on COME is markedly understudied. The goal of this study was to examine the in vitro effects of S. epidermidis lysates on murine and human middle ear epithelial cells. METHODS Staphylococcus epidermidis lysates were generated and used to stimulate submerged and differentiated human and murine epithelial cells (MEECs) for 24 to 48 hours. Quantitative real time-polymerase chain reaction, Western blot, enzyme-linked immunosorbent assay, and immunocytochemistry techniques were performed to interrogate the mucin gene MUC5AC and MUC5B expression and protein production, chemokine response, as well as NF-κB activation. Luciferase reporter assays were performed to further evaluate nuclear factor κB (NF-κB) activation and query specific promoter responses after S. epidermidis exposure. RESULTS Staphylococcus epidermidis induced a time- and dose-dependent MUC5AC and MUC5B overexpression along with a parallel overexpression of Cxcl2 in mouse MEEC and IL-8 in human MEEC. Further investigations in mMEEC showed a 1.3 to 1.5 induction of the MUC5AC and MUC5B promoters. As potential mechanisms for these responses, induction of an oxidative stress marker, along with early nuclear translocation and activation of NF-κB, was found. Finally, chronic exposure induced marked epithelial thickening of cells differentiated at the air liquid interface. CONCLUSIONS Staphylococcus epidermidis lysates activate a proinflammatory response in MEEC, including mucin gene expression and protein production. Although typically considered a nonpathogenic commensal organism in the ear, these results suggest that they may play a role in the perpetuation of an inflammatory and mucogenic response in COME.
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130
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Ruhl D, Camacho M, Lustik M, Cable B. Head and Neck Complications after PCV7 Vaccine. Otolaryngol Head Neck Surg 2015; 153:155-6. [DOI: 10.1177/0194599815583976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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131
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Walls A, Pierce M, Krishnan N, Steehler M, Harley EH. Response to Letter to the Editor Regarding. Otolaryngol Head Neck Surg 2015; 153:156. [DOI: 10.1177/0194599815583977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Groth C, Thomsen RW, Ovesen T. Association of pneumococcal conjugate vaccination with rates of ventilation tube insertion in Denmark: population-based register study. BMJ Open 2015; 5:e007151. [PMID: 26048205 PMCID: PMC4458579 DOI: 10.1136/bmjopen-2014-007151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine if the introduction of pneumococcal conjugate vaccine (PCV) in Denmark was associated with a decrease in the rate of ventilation tube (VT) insertions performed by office-based practising ear, nose and throat (ENT) specialists. DESIGN Population-based register study based on prospectively collected data. SETTING Central Denmark Region. Data on VT insertions performed by any office-based practising ENT specialist in the region were collected from the National Health Service Registry. PARTICIPANTS All children below the age of 2 years with a first-time VT insertion from 2001 through 2011. MAIN OUTCOME MEASURES Age-stratified and gender-stratified standardised incidence rates of first-time VT insertion, and incidence rate ratio for PCV period 2008-2011 compared with pre-PCV period 2001-2007. RESULTS The annual incidence rate of first-time VT insertion in small children increased steadily from 64/1000 person-years in 2001 to 100/1000 person-years in 2011. The incidence rate ratio was 1.27 (95% CI 1.24 to 1.30) in the PCV period compared with the pre-PCV period. CONCLUSIONS The introduction of PCV into the Danish childhood immunisation programme in 2007 was not associated with a subsequent decrease in the rate of VT insertions among children below the age of 2 years. Instead, the rate continued to rise, as before the introduction of PCV. TRIAL REGISTRATION NUMBER Danish Data Protection Agency: 2007-58-0010.
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Affiliation(s)
- Christina Groth
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus C, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus C, Denmark
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Therapeutic Transcutaneous Immunization with a Band-Aid Vaccine Resolves Experimental Otitis Media. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:867-74. [PMID: 26018536 DOI: 10.1128/cvi.00090-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/14/2015] [Indexed: 12/30/2022]
Abstract
Transcutaneous immunization (TCI) is a noninvasive strategy to induce protective immune responses. We describe TCI with a band-aid vaccine placed on the postauricular skin to exploit the unique organization of the stratum corneum and to promote the development of immune responses to resolve active experimental otitis media due to nontypeable Haemophilus influenzae (NTHI). This therapeutic immunization strategy induced significantly earlier resolution of middle ear fluid and rapid eradication of both planktonic and mucosal biofilm-resident NTHI within 7 days after receipt of the first immunizing band-aid vaccine. Efficacy was ascribed to the homing of immunogen-bearing cutaneous dendritic cells to the nasal-associated lymphoid tissue, induction of polyfunctional CD4(+) T cells, and the presence of immunogen-specific IgM and IgG within the middle ear. TCI using band-aid vaccines could expand the use of traditional parenteral preventative vaccines to include treatment of active otitis media, in addition to other diseases of the respiratory tract due to NTHI.
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Holstiege J, Enders D, Schink T, Innocenti F, Oteri A, Bezemer I, Kaguelidou F, Molokhia M, Poluzzi E, Puccini A, Ulrichsen SP, Sturkenboom MC, Trifirò G, Garbe E. Trends in paediatric macrolide use in five European countries—a population-based study. Eur J Clin Pharmacol 2015; 71:991-9. [DOI: 10.1007/s00228-015-1870-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
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Kordeluk S, Kraus M, Leibovitz E. Challenges in the Management of Acute Mastoiditis in Children. Curr Infect Dis Rep 2015; 17:479. [DOI: 10.1007/s11908-015-0479-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thomas JP, Berner R, Zahnert T, Dazert S. Acute otitis media--a structured approach. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:151-9; quiz 160. [PMID: 24661591 DOI: 10.3238/arztebl.2014.0151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Two-thirds of all children have an episode of acute otitis media (AOM) before their third birthday. Antibiotic treatment is often given immediately, even though adequate scientific evidence for this practice is lacking. METHOD This review is based on a selective literature search including previously published evidence-based recommendations, particularly those of the current American guidelines. RESULTS A purulent tympanic effusion, possibly associated with inflammation of the tympanic membrane, is indicative of AOM. Only some patients with AOM need immediate antibiotic treatment: children with severe otalgia and/or fever of 39.0°C or above, infants under 6 months of age, and children with certain specific risk factors, including immune deficiency and Down syndrome. In other cases, symptomatic treatment is appropriate. Antibiotic therapy (preferably with amoxicillin) should be initiated only if the symptoms and signs do not improve within two to three days. CONCLUSION As the currently available data are not fully consistent, there is still a need for controlled trials with well-defined endpoints to determine the relative benefits of immediate antibiotic treatment versus two to three days of watchful waiting.
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Affiliation(s)
- Jan Peter Thomas
- Department of Otorhinolaryngology and Head and Neck Surgery, Ruhr University of Bochum, Department of Child and Adolescent Medicine, Technical University of Dresden(Carl Gustav Carus University Hospital Dresden), Department of Otorhinolaryngology, Technical University of Dresden (Carl Gustav Carus University Hospital Dresden)
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Danhauer JL, Johnson CE, Baker JA, Ryu JA, Smith RA, Umeda CJ. Will Parents Participate in and Comply With Programs and Regimens Using Xylitol for Preventing Acute Otitis Media in Their Children? Lang Speech Hear Serv Sch 2015; 46:127-40. [DOI: 10.1044/2015_lshss-14-0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 12/08/2014] [Indexed: 11/09/2022] Open
Abstract
Purpose
Antiadhesive properties in xylitol, a natural sugar alcohol, can help prevent acute otitis media (AOM) in children by inhibiting harmful bacteria from colonizing and adhering to oral and nasopharyngeal areas and traveling to the Eustachian tube and middle ear. This study investigated parents' willingness to use and comply with a regimen of xylitol for preventing AOM in their preschool- and kindergarten-aged children.
Method
An Internet questionnaire was designed and administered to parents of young children in preschool and kindergarten settings.
Results
Most parents were unaware of xylitol's use for AOM and would not likely comply with regimens for preventing AOM in their children; however, parents having previous knowledge of xylitol and whose children had a history of AOM would be more likely to do so.
Conclusions
Generally, most of these parents did not know about xylitol and probably would not use it to prevent ear infections. Unfortunately, these results parallel earlier findings for teachers and schools, which present obstacles for establishing ear infection prevention programs using similar protocols for young children. The results showed that considerable education and age-appropriate vehicles for administering xylitol are needed before establishing AOM prevention programs in schools and/or at home.
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Fiks AG, Zhang P, Localio AR, Khan S, Grundmeier RW, Karavite DJ, Bailey C, Alessandrini EA, Forrest CB. Adoption of electronic medical record-based decision support for otitis media in children. Health Serv Res 2015; 50:489-513. [PMID: 25287670 PMCID: PMC4369219 DOI: 10.1111/1475-6773.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence. STUDY SETTING A total of 41,391 OM visits with 108 clinicians at 16 pediatric practices between February 2009 and August 2010. STUDY DESIGN Prospective cohort study of EHR-based CDS adoption during OM visits, comparing clinicians receiving performance feedback to none. CDS was available to all physicians; use was voluntary. DATA COLLECTION Extraction from a common EHR. PRINCIPAL FINDINGS Clinicians and practices used the CDS system for a mean of 21 percent (range: 0-85 percent) and 17 percent (0-51 percent) of eligible OM visits, respectively. Clinicians who received performance feedback reports summarizing CDS use and guideline adherence had a relative increase in CDS use of 9.0 percentage points compared to others (p = .001). CDS adoption was associated with increased OM guideline adherence. Effects were greatest among clinicians with the lowest adherence prior to the study. CONCLUSIONS Performance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows.
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Affiliation(s)
- Alexander G Fiks
- Address correspondence to Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia, 3535 Market Street, Room 1546, Philadelphia, PA 19104; e-mail:
| | - Peixin Zhang
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - A Russell Localio
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Saira Khan
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Robert W Grundmeier
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Dean J Karavite
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Charles Bailey
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Evaline A Alessandrini
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Christopher B Forrest
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
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Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev 2015:CD010089. [PMID: 25803008 DOI: 10.1002/14651858.cd010089.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is one of the most common infectious diseases in children. It has been reported that 64% of infants have an episode of AOM by the age of six months and 86% by one year. Although most cases of AOM are due to bacterial infection, it is commonly triggered by a viral infection. In most children it is self limiting, but it does carry a risk of complications. Since antibiotic treatment increases the risk of antibiotic resistance, influenza vaccines might be an effective way of reducing this risk by preventing the development of AOM. OBJECTIVES To assess the effectiveness of influenza vaccine in reducing the occurrence of acute otitis media (AOM) in infants and children. SEARCH METHODS We searched CENTRAL (2014, Issue 6), MEDLINE (1946 to July week 1, 2014), EMBASE (2010 to July 2014), CINAHL (1981 to July 2014), LILACS (1982 to July 2014), Web of Science (1955 to July 2014) and reference lists of articles to July 2014. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing influenza vaccine with placebo or no treatment in infants and children aged younger than six years old. We included children of either sex and of any ethnicity, with or without a history of recurrent AOM. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies, assessed trial quality and extracted data. We performed statistical analyses using the random-effects and fixed-effect models and expressed the results as risk ratio (RR), risk difference (RD) and number needed to treat to benefit (NNTB) for dichotomous outcomes, with 95% confidence intervals (CI). MAIN RESULTS We included 10 trials (six trials in high-income countries and four multicentre trials in high-, middle- and low-income countries) involving 16,707 children aged six months to six years. Eight trials recruited participants from a healthcare setting. Nine trials (and all five trials that contributed to the primary outcome) declared funding from vaccine manufacturers. Four trials reported adequate allocation concealment and nine trials reported adequate blinding of participants and personnel. Attrition was low for all trials included in the analysis.The primary outcome showed a small reduction in at least one episode of AOM over at least six months of follow-up (five trials, 4736 participants: RR 0.80, 95% CI 0.67 to 0.96; RD -0.04, 95% CI -0.07 to -0.02; NNTB 25, 95% CI 15 to 50).The subgroup analyses (i.e. number of courses, settings, seasons or types of vaccine administered) showed no differences.There was a reduction in the use of antibiotics in vaccinated children (two trials, 1223 participants: RR 0.70, 95% CI 0.59 to 0.83; RD -0.15, 95% CI -0.30 to -0.00).There was no significant difference in the utilisation of health care for the one trial that provided sufficient information to be included. The use of influenza vaccine resulted in a significant increase in fever (six trials, 10,199 participants: RR 1.15, 95% CI 1.06 to 1.24; RD 0.02, 95% CI -0.00 to 0.05) and rhinorrhoea (six trials, 10,563 children: RR 1.17, 95% CI 1.07 to 1.29; RD 0.09, 95% CI 0.01 to 0.16) but no difference in pharyngitis. No major adverse events were reported.Compared to the protocol, the review included a subgroup analysis of AOM episodes by season, and changed the types of influenza vaccine from a secondary outcome to a subgroup analysis. AUTHORS' CONCLUSIONS Influenza vaccine results in a small reduction in AOM. The observed reduction with the use of antibiotics needs to be considered in the light of current recommended practices aimed at avoiding antibiotic overuse. Safety data from these trials are limited. The benefits may not justify the use of influenza vaccine without taking into account the vaccine efficacy in reducing influenza and safety data. The quality of the evidence was high to moderate. Additional research is needed.
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Affiliation(s)
- Mohd N Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, 16150
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Atack JM, Winter LE, Jurcisek JA, Bakaletz LO, Barenkamp SJ, Jennings MP. Selection and Counterselection of Hia Expression Reveals a Key Role for Phase-Variable Expression of Hia in Infection Caused by Nontypeable Haemophilus influenzae. J Infect Dis 2015; 212:645-53. [PMID: 25712964 DOI: 10.1093/infdis/jiv103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/13/2015] [Indexed: 11/12/2022] Open
Abstract
Hia is a major adhesin of nontypeable Haemophilus influenzae (NTHi) and has long been investigated as a vaccine candidate. Here we show that Hia phase variation is controlled by changes in the length of a polythymidine tract located in the hia promoter. Studies of an invasive clinical isolate (strain R2866) show that strains expressing high Hia levels are more efficiently killed by opsonophagocytosis. An opsonophagocytic assay was used to select for a subpopulation of variants that expressed a low level of Hia, which facilitated their escape from killing by anti-Hia antisera. Conversely, a subpopulation of variants expressing a high level of Hia was selected for during passaging through Chang cells. In both cases, phase variation of Hia expression corresponded directly with discrete modal changes in polythymidine tract length. In the chinchilla model of NTHi infection, we observed consistent selection for high Hia expression upon nasopharyngeal colonization, confirming the key role of phase-variable expression of Hia within a specific niche in vivo.
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Affiliation(s)
- John M Atack
- Institute for Glycomics, Griffith University, Gold Coast, Australia
| | - Linda E Winter
- Department of Pediatrics, Saint Louis University School of Medicine Pediatric Research Institute, Cardinal Glennon Children's Medical Center, Saint Louis, Missouri
| | - Joseph A Jurcisek
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Lauren O Bakaletz
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Stephen J Barenkamp
- Department of Pediatrics, Saint Louis University School of Medicine Pediatric Research Institute, Cardinal Glennon Children's Medical Center, Saint Louis, Missouri
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141
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Evidence-based management of otitis media: a 5S model approach. The Journal of Laryngology & Otology 2015; 129:112-9. [DOI: 10.1017/s0022215114003363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:The 5S model proposes five hierarchical levels (systems, summaries, synopses, syntheses and studies) of pre-appraised evidence to guide evidence-based practice. This review aimed to identify and summarise pre-appraised evidence at the highest available 5S level for the management of different subsets of otitis media: acute otitis media, otitis media with effusion, chronic suppurative otitis media and cholesteatoma in both adults and children.Method:Data sources were pre-appraised evidence resources. Evidence freely available from sources at the highest available level of the 5S model were summarised for this review.Results:System level evidence exists for acute otitis media and otitis media with effusion. Summary level evidence exists for recurrent acute otitis media and medical management of chronic suppurative otitis media. There is an absence of randomised controlled trials to prove the efficacy of surgical management of chronic suppurative otitis media and cholesteatoma.Conclusion:Until randomised controlled trial data are generated, consensus publications on the surgical management of chronic suppurative otitis media and cholesteatoma should be used to guide best practice.
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142
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Monroy GL, Shelton RL, Nolan RM, Nguyen CT, Novak MA, Hill MC, McCormick DT, Boppart SA. Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media. Laryngoscope 2015; 125:E276-82. [PMID: 25599652 DOI: 10.1002/lary.25141] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/17/2014] [Accepted: 12/15/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE/HYPOTHESIS In this study, optical coherence tomography (OCT) is used to noninvasively and quantitatively determine tympanic membrane (TM) thickness and the presence and thickness of any middle-ear biofilm located behind the TM. These new metrics offer the potential to differentiate normal, acute, and chronic otitis media (OM) infections in pediatric subjects. STUDY DESIGN Case series with comparison group. METHODS The TM thickness of 34 pediatric subjects was acquired using a custom-built, handheld OCT system following a traditional otoscopic ear exam. RESULTS Overall thickness (TM and any associated biofilm) was shown to be statistically different for normal, acute, and chronic infection groups (normal-acute and normal-chronic: P value < 0.001; acute-chronic: P value = 0.0016). Almost all observed scans from the chronic group had an accompanying biofilm structure. When the thickness of the TM and biofilm were considered separately in chronic OM, the chronic TM thickness correlated with the normal group (P value = 0.68) yet was still distinct from the acute OM group (P value < 0.001), indicating that the TM in chronic OM returns to relatively normal thickness levels. CONCLUSION Identifying these physical changes in vivo provides new metrics for noninvasively and quantitatively differentiating normal, acute, and chronic OM. This new diagnostic information has the potential to assist physicians to more effectively and efficiently screen, manage, and refer patients based on quantitative data. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Guillermo L Monroy
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A
| | - Ryan L Shelton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A
| | - Ryan M Nolan
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A
| | - Cac T Nguyen
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A
| | - Michael A Novak
- Department of Surgery, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A.,Department of Otolaryngology, Urbana, Illinois, U.S.A
| | - Malcolm C Hill
- Department of Pediatrics, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A.,Department of Pediatrics, Urbana, Illinois, U.S.A
| | - Daniel T McCormick
- Carle Foundation Hospital, Urbana, Illinois, U.S.A.,Advanced MEMS, San Francisco, California, U.S.A
| | - Stephen A Boppart
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A.,Department of Internal Medicine, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, U.S.A
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Lee HJ, Kim JH, Park SK, Kim HJ. The diagnosis and management of otitis media in children. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.7.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Su-Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chunchen, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chunchen, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
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Otitis Externa, Otitis Media, and Mastoiditis. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7173526 DOI: 10.1016/b978-1-4557-4801-3.00062-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Kaur R, Czup K, Casey JR, Pichichero ME. Correlation of nasopharyngeal cultures prior to and at onset of acute otitis media with middle ear fluid cultures. BMC Infect Dis 2014; 14:640. [PMID: 25475135 PMCID: PMC4264249 DOI: 10.1186/s12879-014-0640-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/18/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We sought to determine if nasopharyngeal (NP) cultures taken at times of healthy visits or at onset of acute otitis media (AOM) could predict the otopathogen mix and antibiotic-susceptibility of middle ear isolates as determined by middle ear fluid (MEF) cultures obtained by tympanocentesis. METHODS During a 7-year-prospective study of 619 children from Jun 2006-Aug 2013, NP cultures were obtained from 6-30 month olds at healthy visits and NP and MEF (by tympanocentesis) at onset of AOM episodes. RESULTS 2601 NP and 530 MEF samples were collected. During healthy visits, S. pneumoniae (Spn) was isolated from 656 (31.7%) NP cultures compared to 253 (12.2%) for Nontypeable Haemophilus influenzae (NTHi) and 723 (34.9%) for Moraxella catarrhalis (Mcat). At onset of AOM 256 (48.3%) of 530 NP samples were culture positive for Spn, 223 (42%) for NTHi and 251 (47.4%) for Mcat, alone or in combinations. At 530 AOM visits, Spn was isolated from 152 (28.7%) of MEF compared to 196 (37.0%) for NTHi and 104 (19.6%) for Mcat. NP cultures collected at onset of AOM but not when children were healthy had predictive value for epidemiologic antibiotic susceptibility pattern assessments. CONCLUSIONS NP cultures at onset of AOM more closely correlate with otopathogen mix than NP cultures at healthy visits using MEF culture as the gold standard, but the correlation was too low to allow NP cultures to be recommended as a substitute for MEF culture. For epidemiology purposes, antibiotic susceptibility of MEF isolates can be predicted by NP culture results when samples are collected at onset of AOM.
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Affiliation(s)
- Ravinder Kaur
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, 14621, Rochester, NY, USA.
| | - Katerina Czup
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, 14621, Rochester, NY, USA.
| | - Janet R Casey
- Otitis Media Research Center, Legacy Pediatrics, Rochester, NY, USA.
| | - Michael E Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, 14621, Rochester, NY, USA.
- Otitis Media Research Center, Legacy Pediatrics, Rochester, NY, USA.
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146
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Woods CR, Jones VF. Variation in antimicrobial prescribing for otitis media by race: different wrinkle in disparity? Pediatrics 2014; 134:1204-6. [PMID: 25404723 DOI: 10.1542/peds.2014-3056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Charles R Woods
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - V Faye Jones
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
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147
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Abstract
BACKGROUND AND OBJECTIVE Previous research suggests that physicians may be less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for black versus nonblack children. Our objective was to determine whether race is associated with differences in OM diagnosis and antibiotic prescribing nationally. METHODS We examined OM visit rates during 2008 to 2010 for children ≤14 years old using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We compared OM visits between black and nonblack children, as percentages of all outpatient visits and visit rates per 1000. We compared antibiotic prescribing by race as the percentage of OM visits receiving narrow-spectrum (eg, amoxicillin) versus broader-spectrum antibiotics. We used multivariable logistic regression to examine whether race was independently associated with antibiotic selection for OM. RESULTS The percentage of all visits resulting in OM diagnosis was 30% lower in black children compared with others (7% vs 10%, P = .004). However, OM visits per 1000 population were not different between black and nonblack children (253 vs 321, P = .12). When diagnosed with OM during visits in which antibiotics were prescribed, black children were less likely to receive broad-spectrum antibiotics than nonblack children (42% vs 52%, P = .01). In multivariable analysis, black race was negatively associated with broad-spectrum antibiotic prescribing (adjusted odds ratio 0.59; 95% confidence interval, 0.40-0.86). CONCLUSIONS Differences in treatment choice for black children with OM may indicate race-based differences in physician practice patterns and parental preferences for children with OM.
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Affiliation(s)
| | - Daniel J Shapiro
- School of Medicine, University of California, San Francisco, California
| | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey S Gerber
- Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Adam L Hersh
- Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah
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148
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Taylor JA, Jacobs J. Homeopathic Ear Drops as an Adjunct in Reducing Antibiotic Usage in Children With Acute Otitis Media. Glob Pediatr Health 2014; 1:2333794X14559395. [PMID: 27335917 PMCID: PMC4804695 DOI: 10.1177/2333794x14559395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective. To determine if use of a homeopathic ear drop preparation reduces antibiotic use in children diagnosed with acute otitis media (AOM). Methods. Children 6 months to 11 years old, diagnosed with AOM and managed with a delayed antibiotic approach, were randomized to standard therapy alone or standard therapy plus a homeopathic ear drop preparation. The primary outcome was whether or not the antibiotic prescription given at the index visit was filled during a 12- to 15-day follow-up period. Results. Among 210 enrolled children, follow-up antibiotic data were collected on 206. During the 12- to 15-day follow-up period, fewer parents of children randomized to the homeopathic ear drops group filled the antibiotic prescription compared with those of children receiving standard therapy alone (26.9% and 41.2%, respectively, P = .032). Conclusion. Homeopathic ear drops may be effective in reducing the use of antibiotics in children with AOM managed with a delayed antibiotic approach.
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149
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Abstract
The ongoing childhood obesity epidemic has garnered significant attention among healthcare providers due to its short- and long-term sequelae. Multiple diseases have been associated with obesity, not limited to hypertension, diabetes, and attention deficit hyperactivity disorder. Over the past decade, the relationships between obesity and otologic conditions have been investigated. In this setting, otitis media has remained the focus of research, representing one of the most common pediatric illnesses. Initial studies suggesting a relationship between the two conditions have been supported with epidemiological studies controlling for socioeconomic factors. The purpose of this article is to review our current understanding of the relationship between otitis media and obesity and to discuss the healthcare implications of this association. In addition, several identifiable factors associated with each condition are discussed, as are potential pathophysiologic mechanisms that may help to elucidate the complex and multifactorial relationship between the two disease entities.
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Affiliation(s)
- Sameer Ahmed
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
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150
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OTO-201: nonclinical assessment of a sustained-release ciprofloxacin hydrogel for the treatment of otitis media. Otol Neurotol 2014; 35:459-69. [PMID: 24518407 PMCID: PMC4867991 DOI: 10.1097/mao.0000000000000261] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
HYPOTHESIS OTO-201 can provide sustained release to the middle ear and effectively treat otitis media, when compared with FDA-approved ciprofloxacin otic drop formulations. BACKGROUND There is an unmet medical need for antibiotic therapy that can provide a full course of treatment from a single administration by an otolaryngologist at the time of tympanostomy tube placement, obviating the need for twice daily multiday treatment with short-acting otic drops. METHODS Studies in guinea pigs and chinchillas were conducted. OTO-201 was administered as a single intratympanic injection and compared with the twice daily multi-day treatment with Ciprodex or Cetraxal otic drops. RESULTS OTO-201 demonstrated sustained release of ciprofloxacin in the middle ear compartment for days to approximately 2 weeks depending on the dose. The substantial C(max) values and steady drug exposure yielded by OTO-201 were in contrast to the pulsatile short lasting exposure seen with Ciprodex and Cetraxal. OTO-201 was also effective in a preclinical chinchilla model of Streptococcus pneumoniae-induced otitis media. The degree of cure was comparable to that afforded by Ciprodex and Cetraxal. There was no evidence of middle or inner ear pathology in guinea pigs treated with OTO-201, unlike Ciprodex and Cetraxal, which both demonstrated mild cochlear ototoxicity. No adverse effects of the poloxamer 407 vehicle were noted. CONCLUSION Intratympanic injection of OTO-201 constitutes an attractive treatment option to twice daily multiday dosing with ciprofloxacin ear drops for the treatment of otitis media, as evidenced by superior middle ear drug exposure, efficacy in an acute otitis media model, safety of administration, and convenience of a single dose regimen.
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