Prompted by rising rates of antibiotic resistance, lack of standardized treatment regimens, and new treatment alternatives, the American Academy of Otolaryngology-Head and Neck Surgery convened an expert consensus panel to consider recommendations for the responsible use of antibiotics in chronic suppurative otitis media, tympanostomy tube otorrhea, and otitis externa. The Panel concluded that in the absence of systemic infection or serious underlying disease, topical antibiotics alone constitute first-line treatment for most patients with these conditions, finding no evidence that systemic antibiotics alone or in combination with topical preparations improve treatment outcomes compared with topical antibiotics alone. Topical preparations should be selected on the basis of expected bacteriology and informed knowledge of the risk-benefit of each available preparation. The use of nonototoxic preparations in treating acute otitis externa (when the tympanic membrane is perforated or its status is unknown), chronic suppurative otitis media, and tympanostomy tube otorrhea should be considered.

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Thooperative Outcom Group for ENT ( 0 "'ENT), a clinical outcom project of the Amer· ican Acad my of Otolaryngology-Head a nd Neck urg ry Foundation, was tablish d to a es clini· cal outcom of otolru-yngological car of patients with two di a · s, otiti media and rhinosinus itis.0 ·~NT h a produced a n as ssm e nt tool with many pot ntial a pplication . Jn bru a ry 1996, th Foundation Bo rd of Directors cr al d n w board-I vel po ition , th oord inator for s ar ch E.M.M.l nd oon la t, r r t d a n w sta ff posi- Although Academy membership included experi · enced h ealth services research ers, it was decided that coll abo ration wi th a consulting group with experi ence in dev loping s uch projects wo uld h lp the effort move forwa rd more rapidly on a secure basis. Accord ingly, the Foundation contracted with ova nce, form erly Corning Hea lth Technology Associat s of Washington, DC, a nd bega n to work with Earl Steinberg, MD, MPP, a Cova nc vie ·pr sid ent who had previously I cl a n outcomes study of ca t ract. ovance h ad coll aborated in th e development of th National Eye Outcomes N twork (NEON), with the Am rica n Academy of Ophtha lm ology.3 This proj ect has thr modu les, one each on cataract, di a betic retinopa thy, and gla ucoma.Two top ic areas were sel cted in cons ulta tion with the Academy Board of Directors and th Board of Gov r· nors. titis m di a 4 and rhinosinu itis were selected becau of th eir hi gh incidenc , cost, and importance to the practic of otola ryngology. Task forces with memb rship drawn from th e Academy wer selected to develop a modul for ach topic area. Pa rticipa nts were selected to r p· resent private a nd academic practic , as well as a wide geographi cal ra nge. Each modu l was intended to fun ction ind pend ntly, so that use rs co uld choose to participate in either or both .The task forces met a t Founda tion headqu arters in AJ exa ndri a, Virginia, in Nov mb r 1996. After an initi al ori nt tion together, the groups met se parately to defin e th processes of care for ach di order, to develop a qu S· tion s t tom asure the clinical outcom of that care, a nd to coll ct related da ta. The groups consid ered carefull y what data would be of greatest value to participants. To maxi mi z pa rticipation, a conce rted effort was made to cla rify th wording of each qu stion a nd to keep the questio n se ts as short as possibl e.Each modu le incorporat cl a disease-specific out. com s ssessment instrument. The task forces worked to nha nc th preci sion of the questionn a ires by limi ting th number of respon se choices a nd using forced-choice qu s tion s as much as possibl e. Reca ll times for primary outcom measures were cho n to b appropri ate for the natur of the illness. Th e task fore s ought ways to ad d value to pa rticipation by capturing data on referral patMansell and Holzer: Development of COG*ENT

No abstract

This study was designed to address a concern about the conversion of vaginal imidazoles from prescription only to over‐the‐counter OTC status. The Food and Drug Administration (FDA) was concerned that women may misdiagnose a venereal disease as candidiasis and delay effective medical therapy for the venereal disease by using the OTC product. We conducted an epidemiology study in Michigan Medicaid (1984) to determine the rate of venereal disease in women with vaginal candidiasis. The Medicaid population was selected because it was high‐risk markers for sexually transmitted diseases (STD) — low socioeconomic status and a high proportion of blacks. We used the medical and pharmaceutical claims of a 5% random sample of 98,020 women aged from 10 to 60 years with vaginal infections, who were continuously enroled in Medicaid and had no other known medical insurance. We defined a candidiasis episode as beginning with a diagnosis or prescription for candidiasis and followed by a 2 week study period. We excluded episodes with antibiotic therapy or venereal disease in the preceding 2 weeks. The study population included 2518 women with 3507 candidiasis episodes. We used a conservative approach in defining venereal disease to include Trichomonas, chancroid, gonorrhoea, herpes, syphilis, pelvic inflammatory disease (PID) and non‐specific or unidentified STD. These venereal diseases were identified by diagnosis, specific prescription medication or antibiotic therapy for the disease during the 2 week study period. The incidence rate of venereal coinfections was 15.3% and the prevalence rate was 17.0%, predominantly Trichomonas, non‐specific or unidentified STD and PID. The prevalence rate varied with age (10–19 years and 20–40 years) and race (white and black women) from 12.6 to 20.8%. These prevalence rates are probably an overestimate for the general United States population because of the high‐risk population in Michigan Medicaid and the conservative approach used to identify venereal disease. In 1990 after reviewing this study and clinical trial data, the FDA approved prescription vaginal candidiasis medications for OTC use.