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Jokinen S, Ruohola A, Tähtinen PA. Parental experiences and opinions regarding the management of acute otitis media in Finland-a comparative questionnaire between 2006 and 2019. Fam Pract 2024; 41:321-325. [PMID: 37389554 PMCID: PMC11167970 DOI: 10.1093/fampra/cmad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Treatment guidelines for acute otitis media (AOM) have changed over the past 20 years. Watchful waiting is often recommended as an option for antibiotic treatment and the use of proper pain medication is emphasised. OBJECTIVE To study parental experiences and opinions regarding the management of AOM and compare our findings with our previous questionnaire submitted in 2006. METHODS We sent an online survey link through day-care centres and Facebook parental groups in Turku area. Children <4 years of age attending day care were included in the analysis. We asked about the child's history of AOM, parental opinions about AOM treatment, and antibiotic resistance. Results of 2019 were compared with those of 2006. RESULTS Altogether 84% (320/381) and 83% (568/681) of children had had at least 1 episode of AOM in 2019 and 2006, respectively. In 2019, more children had been treated without antibiotics (30% vs. 13%, P < 0.001) and fewer parents thought that antibiotics are necessary for the treatment of AOM (70% vs. 85%, P < 0.001) compared with 2006. The use and knowledge of painkillers had increased over the past 13 years. Painkillers had been given at least once to 93% (296/320) of children in 2019 and 80% (441/552) of children in 2006 (P < 0.001). CONCLUSIONS Today, more parents accept watchful waiting as a treatment option for AOM and give painkillers to their children, which indicates that the education about optimal management of AOM has reached parents.
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Affiliation(s)
- Sylvia Jokinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Aino Ruohola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Paula A Tähtinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
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2
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Kasse GE, Humphries J, Cosh SM, Islam MS. Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review. BMC PRIMARY CARE 2024; 25:8. [PMID: 38166736 PMCID: PMC10759428 DOI: 10.1186/s12875-023-02223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Antibiotic resistance is growing globally. The practice of health professionals when prescribing antibiotics in primary health care settings significantly impacts antibiotic resistance. Antibiotic prescription is a complex process influenced by various internal and external factors. This systematic review aims to summarize the available evidence regarding factors contributing to the variation in antibiotic prescribing among physicians in primary healthcare settings. METHODS This systematic review was conducted based on PRISMA guidelines. We included qualitative, quantitative and mixed methods studies that examined factors influencing prescription practice and variability among primary healthcare physicians. We excluded editorials, opinions, systematic reviews and studies published in languages other than English. We searched studies from electronic databases: PubMed, ProQuest Health and Medicine, Web Science, and Scopus. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (Version 2018). Narrative synthesis was employed to synthesize the result and incorporate quantitative studies. RESULTS Of the 1816 identified studies, 49 studies spanning 2000-2023 were eligible for review. The factors influencing antibiotic prescription practice and variability were grouped into physician-related, patient-related, and healthcare system-related factors. Clinical guidelines, previous patient experience, physician experience, colleagues' prescribing practice, pharmaceutical pressure, time pressure, and financial considerations were found to be influencing factors of antibiotic prescribing practice. In addition, individual practice patterns, practice volume, and relationship with patients were also other factors for the variability of antibiotic prescription, especially for intra-physician prescription variability. CONCLUSION Antibiotic prescription practice in primary health care is a complex practice, influenced by a combination of different factors and this may account for the variation. To address the factors that influence the variability of antibiotic prescription (intra- and inter-physician), interventions should aim to reduce diagnostic uncertainty and provide continuous medical education and training to promote patient-centred care.
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Affiliation(s)
- Gashaw Enbiyale Kasse
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia.
- Department of Clinical Medicine, College of Veterinary Medicine and Animal Science, University of Gondar, Gondar, 196, Ethiopia.
| | - Judy Humphries
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Suzanne M Cosh
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
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3
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AlHefdhi HA, Al Qout MM, Alqahtani AY, Alqahtani MM, Asiri RM, Alshahrani OM, Almoghamer HD, Youssef N, Ghazy RM. Parents' Knowledge of and Attitude toward Acute Otitis Media and Its Treatment in Children: A Survey at Primary Healthcare Centers in the Aseer Region. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1573. [PMID: 37761534 PMCID: PMC10528457 DOI: 10.3390/children10091573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Acute otitis media (AOM) in children aged 5 years old and younger poses a critical health concern, affecting both the general health of children and the emotional well-being of parents. The objective of this study was to evaluate parental understanding, attitudes, and experiences related to AOM and its management, including the use of antibiotics without physician prescription. METHOD A cross-sectional study was carried out during the months of May and June of 2023. To collect data for this study, a validated questionnaire was converted into a Google form and given to parents of children aged 5 years and younger who sought healthcare for their children in primary healthcare centers in Abha city, Aseer region, Saudi Arabia. RESULTS A total of 406 parents participated in this study, 64.8% of them were women and 45.3% of them were in the age range of 25 to 34 years. The majority (90.1%) resided in urban areas and a significant proportion (72.2%) had a university education. Among the respondents, 22.7% agreed that bacteria are the cause of AOM, while 21.7% agreed that it is caused by viruses. A total of 51.0% acknowledged the need for antibiotics in the management of AOM. In terms of treatment, 84.5% and 83.5% believed that analgesics and antibiotics, respectively, were the most effective for otalgia. A substantial portion, 43.1%, 34.7%, and 37.7%, respectively, believed that antibiotics could reduce pain, relieve fever, and prevent recurrence. Almost three-quarters sought medical advice primarily from paediatricians and 37.7% obtained information about AOM from the Internet. Furthermore, almost a third (28.8%) chose not to wait for the physician's appointment and immediately administered antibiotics without the physician's prescription due to concerns about disease progression. Approximately two fifths (38.4%) requested physicians to prescribe antibiotics, a pattern that was in agreement with the actual rate of antibiotic prescriptions (38.4%). CONCLUSIONS A notable deficiency in knowledge and unsafe practices about AOM and its management is evident among parents in the Aseer region. This underscores the pressing need for an educational program aimed at improving parental health literacy regarding otitis media causes and treatments, as well as its preventive measures.
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Affiliation(s)
- Hayfa Abdulkhaleq AlHefdhi
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Maraam Mohammed Al Qout
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.M.A.Q.); (A.Y.A.); (M.M.A.); (R.M.A.); (O.M.A.); (H.D.A.)
| | - Alhanouf Yahya Alqahtani
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.M.A.Q.); (A.Y.A.); (M.M.A.); (R.M.A.); (O.M.A.); (H.D.A.)
| | - Meshal Mohammed Alqahtani
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.M.A.Q.); (A.Y.A.); (M.M.A.); (R.M.A.); (O.M.A.); (H.D.A.)
| | - Roaa Mohammed Asiri
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.M.A.Q.); (A.Y.A.); (M.M.A.); (R.M.A.); (O.M.A.); (H.D.A.)
| | - Omair Mohammed Alshahrani
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.M.A.Q.); (A.Y.A.); (M.M.A.); (R.M.A.); (O.M.A.); (H.D.A.)
| | - Hanan Delem Almoghamer
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.M.A.Q.); (A.Y.A.); (M.M.A.); (R.M.A.); (O.M.A.); (H.D.A.)
| | - Naglaa Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrah-Man University, Riyadh 11671, Saudi Arabia;
| | - Ramy Mohamed Ghazy
- Tropical Health Department, Alexandria University, Alexandria 21561, Egypt
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Shamim MA, Padhi BK, Satapathy P, Siddiq A, Manna S, Aggarwal AK, Al-Ahdal T, Khubchandani J, Henao-Martinez AF, Sah R. Parents' expectation of antibiotic prescriptions for respiratory infections in children: a systematic review and meta-analysis. Ther Adv Infect Dis 2023; 10:20499361231169429. [PMID: 37206057 PMCID: PMC10189844 DOI: 10.1177/20499361231169429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/27/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives Despite most childhood infections being self-limiting, children are among the leading consumers of antibiotics. Little is known about parental expectations of antibiotics for childhood infections. A comprehensive systematic review and meta-analysis was conducted to explore the nature and extent of parental expectations of antibiotic prescriptions for children with respiratory infections. Design Systematic review and meta-analysis. Methods An extensive literature search using six major scientific databases was conducted for all published articles until 7 December 2022. Primary studies reporting parents' expectations of antibiotics for children with upper respiratory tract infections were included after assessment for quality. Heterogeneity between the studies was assessed using the I2 statistic and publication bias was analyzed using funnel plots and Egger regression tests. The primary outcome was a summary estimate of the percentage of parents who expect antibiotics from their physicians when their child presents with an upper respiratory tract infection. Results From a total of 4510 studies found in the initial searches, a final pool of 19 eligible studies with 15,664 individuals was included in this meta-analysis. Nine of the 19 studies were from the United States or Saudi Arabia. The pooled prevalence of parental expectations of antibiotics in the population reviewed was 55.78% (95% CI = 44.60-66.41). There was significant heterogeneity between the studies, but funnel plot and meta-regression did not detect any publication bias. Conclusion More than half of parents expect antibiotics for their children during consultation for upper respiratory tract infections. Such practices may cause undue side effects among children, contribute to the growing burden of antibiotic resistance, and lead to treatment failure for many common infections in the future. To optimize efforts to tackle antimicrobial resistance, shared decision-making and education emphasizing the proper and judicious use of antibiotics are much needed in pediatric healthcare settings. This can also help to manage parents' expectations when seeking antibiotics for their children. Despite pressure from parents, pediatric healthcare providers should continue to advocate for antibiotic use only when warranted and help improve knowledge and awareness amongst parents. Registration The protocol has been registered with PROSPERO (CRD42022364198).
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Affiliation(s)
| | | | - Prakasini Satapathy
- Department of Virology, Postgraduate Institute
of Medical Education and Research, Chandigarh, India
| | | | | | - Arun K. Aggarwal
- Department of Community Medicine and School of
Public Health, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
| | - Tareq Al-Ahdal
- Institute of Global Health, Heidelberg
University, Heidelberg, Germany
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Meherali S, Hartling L, Campbell A, Robin F, Scott S. Parent information needs and experience regarding acute otitis media in children: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:554-562. [PMID: 32998839 DOI: 10.1016/j.pec.2020.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/07/2020] [Accepted: 09/12/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Acute otitis media (AOM)-inflammation of the middle ear-is the most common pediatric condition, affecting up to 75 % of children at some time before age 5 years. Despite the high incidence of AOM in children, it presents diverse challenges to parents who do not have accurate information on AOM and its management. OBJECTIVE To respond to this paucity of information we sought to synthesize the literature to provide a comprehensive understanding of parental information needs and experiences relating to AOMmanagement. This systematic review is an important first step in developing parent-informed knowledge translation tools for AOM to bridge the knowledge-practice gap. PATIENT INVOLVEMENT None. METHOD Four electronic databases were searched and articles were screened according to pre- established inclusion criteria. Articles were included in the review if they (1) examined parental information needs and experiences with respect to AOM; (2) were written in English; and (3) were published from January 2000 onward. RESULTS Out of 1121 articles retrieved, 21 articles met the inclusion criteria. The findings from this review revealed that parents' knowledge about AOM is generally limited. Further, parents were often poorly informed about what AOM was, which resulted in uncertainty about how to help their child with AOM. DISCUSSION Our review findings illustrate that parents of children with AOM have pervasive unmet information needs and information deficits negatively impact AOM management, child and family well-being. PRACTICAL VALUE Parental experiences and information needs identified through this review were used to develop innovative, evidence-based knowledge translation tools for parents of children with AOM.
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6
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Stephens JH, O’Keefe M, Schembri M, Baghurst PA. Parents Need More Support: A Qualitative Study of the Experiences of Australian Parents Who Are Waiting for Surgical Intervention for Their Children With Otitis Media. J Patient Exp 2020; 7:717-725. [PMID: 33294607 PMCID: PMC7705822 DOI: 10.1177/2374373519883495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the experiences, expectations, and motivations of parents/caregivers of children with otitis media who were booked to undergo tympanostomy tube insertion. METHOD A cross-sectional cohort study was conducted using semistructured interviews with 39 parents. Interviews were conducted via telephone and analyzed for key themes. RESULTS Three themes emerged that incorporated a range of subthemes: (1) the impact of the child's underlying condition on the family, (2) the cues and prompts that influenced parents to seek intervention, and (3) the parents' expectations of the health-care system. The child's otitis media disrupted the day-to-day functioning of the family and the child's well-being, but despite this, the families found ways to adapt and cope. Parents were influenced by their friends, family, and medical practitioners when making treatment decisions and had differing expectations of the health-care system. CONCLUSION Parents need support during their child's illness to help with pressures placed on the family and also in making health-care decisions for their child. Clinicians should consider these issues when discussing treatment options with parents.
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Affiliation(s)
- Jacqueline H Stephens
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maree O’Keefe
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Schembri
- Ear, Nose and Throat Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Peter A Baghurst
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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7
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Van Hecke O, Butler CC, Wang K, Tonkin-Crine S. Parents' perceptions of antibiotic use and antibiotic resistance (PAUSE): a qualitative interview study. J Antimicrob Chemother 2020; 74:1741-1747. [PMID: 30879040 PMCID: PMC6524473 DOI: 10.1093/jac/dkz091] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There remains public misconception about antibiotic use and resistance. Preschool children are at particular risk of receiving unnecessary antibiotics because they commonly present in primary care and many childhood infections are self-limiting. OBJECTIVES The aim of our study was to explore parents' perceptions and understanding of antibiotic use and resistance in the context of their young child with an acute respiratory tract infection (RTI) and to explore strategies parents would find acceptable to minimize antibiotic resistance for their families. METHODS Semi-structured interviews were conducted with 23 parents of preschool children who recently had an acute RTI across greater Oxfordshire, UK (2016-17 winter). We explored their beliefs about antibiotics, understanding of antibiotic resistance and views on current public antibiotic awareness campaigns at the time. Thematic analysis was used to analyse the data. RESULTS Parents had a sense of optimism and considered their families to be at low risk of antibiotic resistance because their families were 'low users' of antibiotics. Very few parents considered antibiotic resistance as a possible harm of antibiotics. Parents thought they were acting morally responsibly by following campaign messages. They wanted future campaigns to have a relevant, accessible message for families about the impact of antibiotic resistance. CONCLUSIONS Future communication about the potential impact of unnecessary antibiotic use and antibiotic resistance needs to focus on outcomes that parents of young children can relate to (e.g. infection recurrence) and in a format that parents will engage with (e.g. face-to-face dissemination at playgroups and parent/child community events) to make a more informed decision about the risks and benefits of antibiotics for their child.
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Affiliation(s)
- Oliver Van Hecke
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Chris C Butler
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Kay Wang
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
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Belisle S, Dobrin A, Elsie S, Ali S, Brahmbhatt S, Kumar K, Jasani H, Miller M, Ferlisi F, Poonai N. Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open-label Trial. Acad Emerg Med 2019; 26:1326-1335. [PMID: 31742809 DOI: 10.1111/acem.13839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/27/2019] [Accepted: 07/12/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Thirty percent of children with acute otitis media (AOM) experience symptoms < 7 days after initiating treatment, highlighting the importance of comprehensive discharge instructions. METHODS We randomized caregivers of children 6 months to 17 years presenting to the emergency department (ED) with AOM to discharge instructions using a video on management of pain and fever to a paper handout. The primary outcome was the AOM Severity of Symptom (AOM-SOS) score at 72 hours postdischarge. Secondary outcomes included caregiver knowledge (10-item survey), absenteeism, recidivism, and satisfaction (5-item Likert scale). RESULTS A total of 219 caregivers were randomized and 149 completed the 72-hour follow-up (72 paper and 77 video). The median (IQR) AOM-SOS score for the video was significantly lower than paper, even after adjusting for preintervention AOM-SOS score and medication at home (8 [7-11] vs. 10 [7-13], respectively; p = 0.004). There were no significant differences between video and paper in mean (±SD) knowledge score (9.2 [±1.3] vs. 8.8 [±1.8], respectively; p = 0.07), mean (±SD) number of children that returned to a health care provider (8/77 vs. 10/72, respectively; p = 0.49), mean (±SD) number of daycare/school days missed by child (1.2 [±1.5] vs. 1.1 [±2.1], respectively; p = 0.62), mean (±SD) number of workdays missed by caregiver (0.5 [±1] vs. 0.8 [±2], respectively; p = 0.05), or median (IQR) satisfaction score (5 [4-5] vs. 5 [4-5], respectively; p = 0.3). CONCLUSIONS Video discharge instructions in the ED are associated with less perceived AOM symptomatology compared to a paper handout.
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Affiliation(s)
- Sheena Belisle
- From the Department of Pediatrics Division of Paediatric Emergency Medicine Schulich School of Medicine & Dentistry, Western University London Ontario
| | - Andrei Dobrin
- From the Department of Pediatrics Division of Paediatric Emergency Medicine Schulich School of Medicine & Dentistry, Western University London Ontario
| | - Sharlene Elsie
- From the Department of Pediatrics Division of Paediatric Emergency Medicine Schulich School of Medicine & Dentistry, Western University London Ontario
| | - Samina Ali
- the Department of Pediatrics Division of Paediatric Emergency Medicine University of Alberta Edmonton Alberta
- Women and Children's Health Research Institute Edmonton Alberta
| | - Shaily Brahmbhatt
- From the Department of Pediatrics Division of Paediatric Emergency Medicine Schulich School of Medicine & Dentistry, Western University London Ontario
| | - Kriti Kumar
- From the Department of Pediatrics Division of Paediatric Emergency Medicine Schulich School of Medicine & Dentistry, Western University London Ontario
| | - Hardika Jasani
- From the Department of Pediatrics Division of Paediatric Emergency Medicine Schulich School of Medicine & Dentistry, Western University London Ontario
| | - Michael Miller
- From the Department of Pediatrics Division of Paediatric Emergency Medicine Schulich School of Medicine & Dentistry, Western University London Ontario
- the Children's Health Research Institute London Health Sciences Centre London Ontario
| | - Frank Ferlisi
- and the Department of Family Medicine Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Naveen Poonai
- From the Department of Pediatrics Division of Paediatric Emergency Medicine Schulich School of Medicine & Dentistry, Western University London Ontario
- the Children's Health Research Institute London Health Sciences Centre London Ontario
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van Uum RT, Venekamp RP, Schilder AGM, Damoiseaux RAMJ, Anthierens S. Pain management in acute otitis media: a qualitative study of parents' views and expectations. BMC FAMILY PRACTICE 2019; 20:18. [PMID: 30674279 PMCID: PMC6343236 DOI: 10.1186/s12875-019-0908-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND For unclarified reasons, parents tend to be cautious about administering analgesics to their children, potentially leading to suboptimal management of AOM symptoms. We aim to understand parents' views and expectations of pain management in acute otitis media (AOM) in children. METHODS Qualitative study alongside a cluster-randomised controlled trial (PIM-POM study) aimed at optimising pain management in childhood AOM. We purposefully sampled 14 parents of children diagnosed with AOM by their GP, who were recruited to the trial between November 2017 and May 2018. Semi-structured interviews were held at home in the first two weeks after trial enrollment. Interviews were audio-recorded, transcribed and analyzed thematically. RESULTS Parents experienced difficulties in recognising earache and other symptoms of an ear infection. They consulted the GP for a diagnosis, for reassurance and for management advice. Parents shared that, prior to consultation, they had insufficient knowledge of the benefits of correctly dosed pain medication at regularly scheduled intervals. Parents valued the GP's advice on pain management, and were happy to accept pain medication as standalone therapy, provided that the GP explained why antibiotics would not be needed. Parents' views and expectations of pain management in AOM were shaped by previous experiences of AOM within their family; those with a positive experience of pain medication are more likely to use it in subsequent AOM episodes. CONCLUSIONS Parents of children with AOM consult the GP to help cope with uncertainties in recognising symptoms of AOM, and to receive management advice. It is important that GPs are aware of parents' lack of understanding of the role of pain medication in managing AOM, and that they address this during the consultation. TRIAL REGISTRATION Netherlands Trial Register, identifier NTR4920 (registration date: 19 December 2014).
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Affiliation(s)
- Rick T. van Uum
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Office number FAC 5.09, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Office number FAC 5.09, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Anne G. M. Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Office number FAC 5.09, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
- evidENT, Ear Institute, University College London, London, UK
| | - Roger A. M. J. Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Office number FAC 5.09, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Sibyl Anthierens
- Department of Primary Care and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
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Pain management in acute otitis media: a qualitative study exploring GPs' views and expectations parallel to a trial of an educational intervention. BJGP Open 2018; 2:bjgpopen18X101620. [PMID: 30723805 PMCID: PMC6348326 DOI: 10.3399/bjgpopen18x101620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 11/20/2022] Open
Abstract
Background Optimal pain management is accepted as the cornerstone of acute otitis media (AOM) management, but analgesics are neither prescribed routinely nor explicitly recommended in day-to-day practice. Aim To explore GPs views on and expectations regarding pain management in children with AOM, and how a multifaceted educational intervention aimed at optimising pain management shapes these perceptions. Design & setting Qualitative study conducted alongside a cluster randomised controlled trial (cRCT), the PIMPOM study, in the Netherlands. Method Twelve GPs were purposefully sampled from primary care centres allocated to the intervention group and were interviewed, using semi-structured, audio-recorded interviews. The intervention comprised a blended GP educational programme (internet-based and face-to-face training) aimed at discussing pain management proactively with parents using a parent information leaflet, and prescribing paracetamol and ibuprofen according to current guidelines. Interviews were transcribed verbatim and analysed thematically by a multidisciplinary team. Results GPs considered AOM a very painful condition. Initially, GPs felt unable to offer adequate treatment for AOM-related ear pain. The intervention provided tools, such as knowledge, communication skills, and an information leaflet, which reduced their feelings of helplessness and empowered them to manage childhood AOM more adequately. GPs indicated that the intervention led to a shift in focus from treating the infection with antibiotics to treating symptoms with analgesics. There was a general lack of knowledge about the possibility of prescribing ibuprofen to children. GPs expressed mixed views on prescribing this drug to children. Conclusion A primary-care based multifaceted educational intervention aimed at optimising pain management in childhood AOM offered GPs tools to optimise management of this condition and changed GPs perceptions, namely from treating the infection with antibiotics to treating symptoms.
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van Uum RT, Venekamp RP, Sjoukes A, van de Pol AC, de Wit GA, Schilder AGM, Damoiseaux RAMJ. Optimising pain management in children with acute otitis media through a primary care-based multifaceted educational intervention: study protocol for a cluster randomised controlled trial. Trials 2018; 19:501. [PMID: 30223903 PMCID: PMC6142388 DOI: 10.1186/s13063-018-2880-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Whilst current guidelines highlight the importance of pain management for children with acute otitis media (AOM), there is evidence to suggest that this is not implemented in everyday practice. We have developed a primary care-based multifaceted educational intervention to optimise pain management in children with AOM, and we trial its clinical and cost effectiveness. Methods This cluster randomised controlled trial aims to recruit 250 children aged 6 months to 10 years presenting with AOM to general practitioners (GPs) in 30 primary care centres (PCCs) across the Netherlands. GPs in the PCCs allocated to the intervention group receive a blended GP educational programme (online and face-to-face training). The intervention asks GPs to proactively discuss pain management with parents using an information leaflet, and to prescribe paracetamol and ibuprofen according to current guidelines. GPs in both groups complete an online module illustrating various otoscopic images to standardise AOM diagnosis. GPs in the PCCs allocated to the control group do not receive any further training and provide ‘care as usual’. During the 4-week follow-up, parents complete a symptom diary. The primary outcome is the difference in parent-reported mean earache scores over the first 3 days. Secondary outcomes include both number of days with earache and fever, GP re-consultations for AOM, antibiotic prescriptions, and costs. Analysis will be by intention-to-treat. Discussion The optimal use of analgesics through the multifaceted intervention may provide symptom relief and thereby reduce re-consultations and antibiotic prescriptions in children with AOM. Trial registration Netherlands Trial Register, NTR4920. Registered on 19 December 2014. Electronic supplementary material The online version of this article (10.1186/s13063-018-2880-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rick T van Uum
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 5.143, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 5.143, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Alies Sjoukes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 5.143, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Alma C van de Pol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 5.143, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 5.143, PO Box 85500, 3508, GA, Utrecht, The Netherlands.,Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Anne G M Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 5.143, PO Box 85500, 3508, GA, Utrecht, The Netherlands.,evidENT, Ear Institute, University College London, London, UK
| | - Roger A M J Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Stratenum 5.143, PO Box 85500, 3508, GA, Utrecht, The Netherlands
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Factors affecting the public awareness and behavior on antibiotic use. Eur J Clin Microbiol Infect Dis 2018; 37:1547-1552. [PMID: 29777487 DOI: 10.1007/s10096-018-3283-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/11/2018] [Indexed: 10/16/2022]
Abstract
To evaluate the effects of demographic and perceptive factors on the knowledge, perception, and behavior regarding antibiotic use in the general public, we conducted three serial telephone interview surveys in 2010, 2012, and 2015. Computer-aided telephone interview was conducted, with a predetermined quota stratified by sex, age, and geographic location. Respondents who answered correctly to four or more questions were categorized as having better knowledge. A total of 3013 respondents participated. Better knowledge was associated with age < 60 years (OR 1.37, 95% CI 1.04-1.82), college education (OR 1.57, 95% CI 1.26-1.97), healthcare-related occupation or education (OR 2.26, 95% CI 1.52-3.36), and media exposure (OR 1.25, 95% CI 1.02-1.54). In contrast, correct antibiotic use behavior was associated with male sex (OR 1.48, 95% CI 1.27-1.73), older age (OR 1.63, 95% CI 1.34-1.99), and being married (OR 1.26, 95% CI 1.04-1.52), along with better knowledge (OR 1.43, 95% CI 1.19-1.71). However, multifaceted analysis indicated that better knowledge was associated with correct behavior in all subgroups. Other demographic factors were associated only in respondents with poor knowledge. Various factors other than knowledge on antibiotics, many of them traditionally underappreciated, affect antibiotic use behavior.
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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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Fortanier AC, Venekamp RP, de Hoog MLA, Uiterwaal CSPM, van der Gugten AC, van der Ent CK, Hoes AW, Schilder AGM. Parent-reported symptoms of acute otitis media during the first year of life: what is beneath the surface? PLoS One 2015; 10:e0121572. [PMID: 25849847 PMCID: PMC4388588 DOI: 10.1371/journal.pone.0121572] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 02/17/2015] [Indexed: 11/24/2022] Open
Abstract
Background Most estimates of the incidence of acute otitis media (AOM) are based on general practitioner (GP) or pediatrician diagnoses. It is likely that these figures underestimate the community incidence of AOM since parents do not visit their doctor every time their child suffers from acute ear symptoms. The impact of these symptom episodes may be substantial since they affect the child’s quality of life and parents’ productivity. Methods To determine AOM symptoms in the community, we measured parent-reported AOM symptoms daily for 12 consecutive months in 1,260 children participating in a prospective birth cohort in the Netherlands. The mean age of these children was at study enrollment 0.9 months (standard deviation 0.6). A parent-reported AOM symptom episode was defined as fever (temperature 38˚C or above) plus at least one of the following symptoms: ear pain and ear discharge. These febrile AOM symptom episodes were linked to GP-consultations and diagnoses in the GP electronic health records. Results With an estimated 624 parent-reported symptom episodes per 1,000 child-years (95% CI: 577 to 674) incidence of febrile AOM symptoms during the child’s first year is high. The GP was consulted in half of these symptom episodes and AOM was diagnosed in 49% of these consultations. Conclusions and Relevance The incidence of febrile AOM symptoms in the first year of life is high in Dutch children and leads to a GP-consultation in only half of the cases. This suggests that AOM symptomatology in the community is underestimated when focusing on GP-diagnosed AOM episodes alone, since a considerable proportion of febrile AOM symptom episodes are treated symptomatically by parents at home and do not come to the attention of the GP. Having data on community AOM symptomatology available for each country is important when the potential impact of preventive and therapeutic interventions for AOM are studied.
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Affiliation(s)
- Alexandre C. Fortanier
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Marieke L. A. de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne C. van der Gugten
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne G. M. Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ear Institute, University College London, London, United Kingdom
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Barber C, Ille S, Vergison A, Coates H. Acute otitis media in young children - what do parents say? Int J Pediatr Otorhinolaryngol 2014; 78:300-6. [PMID: 24374143 DOI: 10.1016/j.ijporl.2013.11.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 11/21/2013] [Accepted: 11/24/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The Ear infections Attitudes Research study investigated parental attitudes and awareness towards acute otitis media (AOM) and evaluated the burden of AOM for affected children, their families, and parental work capabilities. METHODS This study, conducted via online interviews in October-November 2010, included parents (N=2867) from 12 countries, whose children aged ≤3.5 years had experienced ≥1 professionally diagnosed AOM episode in the last 6 months (AOM-experienced group; N=1438) or had never experienced any professionally diagnosed AOM episode (non AOM-experienced group; N=1429). The interviews consisted of questions with multiple-choice, five-point scaled or free-text answers. Answers to multiple-choice questions were presented as frequencies of particular responses and those to scaled questions as mean values or percentages of parents considering each aspect as applicable. RESULTS Parents considered that the main AOM burdens for affected children were pain (mean values on five-point scales: 4.4 and 4.5), disturbed sleep (4.3 and 4.3) and irritability (4.2 and 4.0) and for their families, sleepless nights (4.2 and 3.8) and worries about the child's recovery (4.1 and 4.3) and about potential long-term implications (4.0 and 4.3) in the AOM-experienced and non AOM-experienced groups, respectively. During their child's most recent AOM episode, 95% of parents in the AOM-experienced group used antibiotics, 76% reported that their doctors prescribed antibiotics for immediate use, 13% were advised to return for antibiotic prescription if symptoms did not abate and 9% received a prescription for antibiotics to use if symptoms did not improve. Both reported prescription and usage rates for antibiotics were higher than expected. When their child had AOM, 73% of parents had to be absent from work or rearrange their working hours. Among those who took leave from work, 67% stayed at home for 2-7 days. CONCLUSIONS Parents perceive AOM to be a burden for their child and families, particularly the pain and disturbed sleep due to AOM, and this disease had a significant effect on parents' ability to attend work. Given how common AOM is, this loss of workdays may lead to substantial financial burden for families and the society. Antibiotics were almost invariably used in all countries despite current guidelines.
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Affiliation(s)
- Colin Barber
- Department of Paediatric Otolaryngology, Starship Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand.
| | | | - Anne Vergison
- Department of Paediatric Infectious Diseases, Infection Control and Epidemiology Unit, ULB-Hopital Universitaire Des Enfants, J.J. Crocq 15, 1020 Brussels (Laken), Belgium.
| | - Harvey Coates
- School of Paediatrics and Child Health, The University of Western Australia, Perth, 208 Hampden Road, Nedlands, Western Australia 6009, Australia.
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Marchisio P, Chonmaitree T, Leibovitz E, Lieberthal A, Lous J, Mandel E, McCormick D, Morris P, Ruohola A. Panel 7: Treatment and comparative effectiveness research. Otolaryngol Head Neck Surg 2013; 148:E102-21. [PMID: 23536528 DOI: 10.1177/0194599812465397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Otitis media (OM) is one of the most common reasons for antibiotic treatment in children. Controversies regarding antibiotic treatment for OM have accumulated in the past decade, and there seem to be more dilemmas than certainties. The objectives of this article are to provide the state-of-the art review on achievements in treatment of all different stages of OM, including acute otitis media (AOM), otitis media with effusion (OME), and chronic suppurative otitis media, and to outline the future research areas. DATA SOURCES PubMed, Ovid Medline, the Cochrane Database, and Clinical Evidence (BMJ Publishing). REVIEW METHODS All types of articles related to OM treatment published in English between January 2007 and June 2011 were identified. A total of 286 articles related to OM treatment were reviewed by the panel members; 114 relevant quality articles were identified and summarized. RESULTS New evidence emerged on beneficial results of antibiotic treatment, compared with observation of AOM in young children who were diagnosed based on stringent criteria. In OME, the main results were related to a nonsignificant benefit of adenoidectomy versus tympanostomy tube placement alone in the treatment of chronic OME in younger children. Other modalities of OM treatment were studied and described herein. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Significant progress has been made in advancing the knowledge on the treatment of OM. Areas of potential future research have been identified and outlined.
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Affiliation(s)
- Paola Marchisio
- Department of Pathophysiology and Transplantation, University of Milan and Fondazione IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Ryborg CT, Søndergaard J, Lous J, Munck A, Larsen PV, Hansen MP, Thomsen JL. Factors associated with antibiotic prescribing in children with otitis media. ISRN FAMILY MEDICINE 2013; 2013:587452. [PMID: 24967325 PMCID: PMC4041257 DOI: 10.5402/2013/587452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/30/2013] [Indexed: 11/23/2022]
Abstract
Background. Acute otitis media (AOM) is often treated with antibiotics. However, initial observation is recommended. Denmark has a low use of antibiotics compared with other countries, but the total use of antibiotics has increased by 32% during the last decade, and it is important to know whether general practitioners (GPs) prescribe antibiotics according to guidelines. Objective. The aim of the study was to analyse associations between GPs' antibiotic prescribing for AOM and symptoms, diagnoses, and characteristics of children. Methods. A cohort study where GPs consecutively included 954 children between 0 and 7 years old with a new ear symptom was carried out. The GPs registered symptoms, results of otoscopy and tympanometry, together with diagnosis and treatment. Results. Fever with and without earache was statistically associated with prescribing antibiotics, and it applies to both children up to two years of age (OR: 5.89 (confidence interval (CI): 2.62-13.21) and OR: 8.13 (CI: 4.61-14.32)) and children older than two years of age (OR: 4.59 (CI: 2.55-8.25) and OR: 19.45 (CI: 6.38-59.24)). A red tympanic membrane was statistically associated with the prescribing antibiotics in both age groups (0-2 years: OR: 4.73 (CI: 2.52-8.86) and >2-7 years: OR: 3.76 (CI: 2.13-6.64)). A flat tympanometry curve was only statistically associated with prescribing antibiotics in the oldest children (OR: 2.42 (CI: 1.17-5.00)). Conclusion. This study indicates that GPs to a large degree prescribe antibiotics appropriately according to guidelines.
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Affiliation(s)
- Christina T. Ryborg
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Jørgen Lous
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Anders Munck
- Audit Project Odense, Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Denmark
| | - Pia V. Larsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | | | - Janus Laust Thomsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
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