Predictors of Pain and/or Fever at 3 to 7 Days for Children With Acute Otitis Media Not Treated Initially With Antibiotics: A Meta-analysis of Individual Patient Data

Rovers, Maroeska M.; Glasziou, Paul; Appelman, C. L. M.; Burke, Peter; McCormick, David P.; Damoiseaux, Roger; Little, Paul; Saux, Nicole Le; Hoes, Arno W.

doi:10.1542/peds.2006-2092

Cited by 49 publications

(44 citation statements)

References 34 publications

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“…56 Pain associated with AOM can be substantial in the first few days of illness and often persists longer in young children. 57 Antibiotic therapy of AOM does not provide symptomatic relief in the first 24 hours 58-61 and even after 3 to 7 days, there may be persistent pain, fever, or both in 30% of children younger than 2 years. 62 In contrast, analgesics do relieve pain associated with AOM within 24 hours 63 and should be used whether antibiotic therapy is or is not prescribed; they should be continued as long as needed.…”

Section: Treatment Of Otalgiamentioning

confidence: 99%

“…Children younger than 2 years with AOM may take longer to improve clinically than older children, 57 and although they are more likely to benefit from antibiotics, 31,32 AOM in many children will resolve without antibiotics. 62 A clinically significant benefit of immediate antibiotic therapy is observed for bilateral AOM, 62,96 Streptococcus pneumoniae infection, or AOM associated with otorrhea.…”

Section: Initial Antibiotic Therapymentioning

confidence: 99%

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The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

1,062

832

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This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM.In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations.The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships.The practice guideline underwent comprehensive peer review before formal approval by the AAP.This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem. Pediatrics 2013;131:e964-e999

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Section: Treatment Of Otalgiamentioning

confidence: 99%

Section: Initial Antibiotic Therapymentioning

confidence: 99%

The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

1,062

832

View full text Add to dashboard Cite

show abstract

“…It has been confirmed that these children benefit more from immediate antibiotic treatment (IA) 37 .…”

Section: Groups At Risk For a Poor Outcome: Immediate Antibiotic Treamentioning

confidence: 96%

“…All the reasons explained above, along with the side effects of antibiotics, support the current watchful waiting approach in response to a diagnosis of AOM, and deferring antibiotic treatment for cases with poor outcomes (those who have not improved in 48-72 hours) [34][35][36][37] (IA). When taking this approach, the physician must be sure that he will be able to follow up with the patient 1,19,25 .…”

Section: Antibiotic Treatment or The Watchful Waiting Approachmentioning

confidence: 99%