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Age inconsistency in the American Academy of Pediatrics guidelines for acute otitis media.
Pediatrics 2008; 121(4):657-68Ped

Abstract

OBJECTIVE

The American Academy of Pediatrics acute otitis media guidelines could reduce antibiotic use. The objective was to compare strategies for diagnosing and treating otitis: (1) a commonly used, 2-criteria strategy, (2) the guidelines' 3-criteria algorithm, and (3) initially watching without antibiotics.

METHODS

A decision analysis was performed with literature-based parameter. The target population was children presenting to primary care physicians with possible otitis media. Main outcomes were antibiotic use, sick days, mild adverse drug events, and number needed to treat/avoided sick day.

RESULTS

For children 2 to <6 months of age, compared with the 2-criteria strategy, guideline use predicted 21% less antibiotic use, 13% more sick days, and 23% fewer adverse drug events; the number needed to treat for the 2-criteria strategy versus the American Academy of Pediatrics strategy was 1.2 children per avoided sick day. For children 6 to <24 months of age, guideline use, compared with the 2-criteria strategy, predicted 26% less antibiotic use, 14% more sick days, and 28% fewer adverse drug events; the number needed to treat for the 2-criteria strategy versus the American Academy of Pediatrics strategy was 1.4 children per avoided sick day. For children >2 years of age, guideline use, compared with the 2-criteria strategy, predicted 67% less antibiotic use, 4% more sick days, and 68% fewer adverse drug events. The number needed to treat for the guideline strategy versus the watch strategy was 6.3 children per avoided sick day; that for the 2-criteria strategy versus the guideline strategy was 12.3. Guideline use for children <2 years implies that our number needed to treat to avoid a sick day is <1.4; for children >2, guideline use implies we are willing to treat at least 6.3 children to avoid a sick day. Thus, the guidelines imply a greater willingness to treat older children, compared with younger children.

CONCLUSIONS

The American Academy of Pediatrics guidelines are inconsistent in their outcomes across age groups. Guideline implementation under age 2 reduces antibiotic use but at a relatively heavy cost of sick days and parental missed work days. This trade-off may be particularly unfavorable for working parents, who might reasonably prefer greater antibiotic use.

Authors+Show Affiliations

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 108 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104, USA. meropols@mail.med.upenn.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18381528

Citation

Meropol, Sharon B., et al. "Age Inconsistency in the American Academy of Pediatrics Guidelines for Acute Otitis Media." Pediatrics, vol. 121, no. 4, 2008, pp. 657-68.
Meropol SB, Glick HA, Asch DA. Age inconsistency in the American Academy of Pediatrics guidelines for acute otitis media. Pediatrics. 2008;121(4):657-68.
Meropol, S. B., Glick, H. A., & Asch, D. A. (2008). Age inconsistency in the American Academy of Pediatrics guidelines for acute otitis media. Pediatrics, 121(4), pp. 657-68. doi:10.1542/peds.2007-1913.
Meropol SB, Glick HA, Asch DA. Age Inconsistency in the American Academy of Pediatrics Guidelines for Acute Otitis Media. Pediatrics. 2008;121(4):657-68. PubMed PMID: 18381528.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Age inconsistency in the American Academy of Pediatrics guidelines for acute otitis media. AU - Meropol,Sharon B, AU - Glick,Henry A, AU - Asch,David A, PY - 2008/4/3/pubmed PY - 2008/5/1/medline PY - 2008/4/3/entrez SP - 657 EP - 68 JF - Pediatrics JO - Pediatrics VL - 121 IS - 4 N2 - OBJECTIVE: The American Academy of Pediatrics acute otitis media guidelines could reduce antibiotic use. The objective was to compare strategies for diagnosing and treating otitis: (1) a commonly used, 2-criteria strategy, (2) the guidelines' 3-criteria algorithm, and (3) initially watching without antibiotics. METHODS: A decision analysis was performed with literature-based parameter. The target population was children presenting to primary care physicians with possible otitis media. Main outcomes were antibiotic use, sick days, mild adverse drug events, and number needed to treat/avoided sick day. RESULTS: For children 2 to <6 months of age, compared with the 2-criteria strategy, guideline use predicted 21% less antibiotic use, 13% more sick days, and 23% fewer adverse drug events; the number needed to treat for the 2-criteria strategy versus the American Academy of Pediatrics strategy was 1.2 children per avoided sick day. For children 6 to <24 months of age, guideline use, compared with the 2-criteria strategy, predicted 26% less antibiotic use, 14% more sick days, and 28% fewer adverse drug events; the number needed to treat for the 2-criteria strategy versus the American Academy of Pediatrics strategy was 1.4 children per avoided sick day. For children >2 years of age, guideline use, compared with the 2-criteria strategy, predicted 67% less antibiotic use, 4% more sick days, and 68% fewer adverse drug events. The number needed to treat for the guideline strategy versus the watch strategy was 6.3 children per avoided sick day; that for the 2-criteria strategy versus the guideline strategy was 12.3. Guideline use for children <2 years implies that our number needed to treat to avoid a sick day is <1.4; for children >2, guideline use implies we are willing to treat at least 6.3 children to avoid a sick day. Thus, the guidelines imply a greater willingness to treat older children, compared with younger children. CONCLUSIONS: The American Academy of Pediatrics guidelines are inconsistent in their outcomes across age groups. Guideline implementation under age 2 reduces antibiotic use but at a relatively heavy cost of sick days and parental missed work days. This trade-off may be particularly unfavorable for working parents, who might reasonably prefer greater antibiotic use. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/18381528/Age_inconsistency_in_the_American_Academy_of_Pediatrics_guidelines_for_acute_otitis_media_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=18381528 DB - PRIME DP - Unbound Medicine ER -