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Reducing the frequency of acute otitis media by individualized care.
Pediatr Infect Dis J 2013; 32(5):473-8PI

Abstract

OBJECTIVE

We sought to determine if use of more stringent diagnostic criteria for acute otitis media (AOM) than currently advocated by the American Academy of Pediatrics, tympanocentesis and pathogen-specific antibiotic treatment (individualized care) would result in reducing the incidence of recurrent AOM and consequent tympanostomy tube surgery.

METHODS

A 5-year longitudinal, prospective study in Rochester, NY, was conducted from July 2006 to July 2011 involving 254 individualized care children. When this individualized care group developed symptoms of AOM, strict diagnostic criteria were applied and a tympanocentesis was performed. Pathogen resistance to empiric high-dose amoxicillin/clavulanate (80 mg/kg of amoxicillin component) caused a change in antibiotic to an optimized choice. Legacy controls (n = 208) were diagnosed with the same diagnostic criteria by the same physicians as the individualized care group and received the same empiric amoxicillin/clavulanate (80 mg/kg of amoxicillin component) but no tympanocentesis or change in antibiotic. Community control children (n = 1020) were diagnosed according to current American Academy of Pediatrics guidelines and treated with high-dose amoxicillin (80 mg/kg) without tympanocentesis as guideline recommended.

RESULTS

5.9% of children of the individualized care group compared with 14.4% of Legacy controls and 27.3% of community controls became otitis prone, defined as 3 episodes of AOM within a 6-month time span or 4 AOM episodes within a 12-month time span (P < 0.0001). 2.4% of the individualized care group compared with 6.3% of Legacy controls, and 14.8% of community controls received tympanostomy tubes (P < 0.0001).

CONCLUSIONS

Individualized care of AOM significantly reduces the frequency of AOM and tympanostomy tube surgery. Use of strict diagnostic criteria for AOM and empiric antibiotic treatment using evidence-based knowledge of circulating otopathogens and their antimicrobial susceptibility profile also produces improved outcomes.

Authors+Show Affiliations

Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester NY 14621, USA. Michael.pichichero@rochestergeneral.org

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23340550

Citation

Pichichero, Michael E., et al. "Reducing the Frequency of Acute Otitis Media By Individualized Care." The Pediatric Infectious Disease Journal, vol. 32, no. 5, 2013, pp. 473-8.
Pichichero ME, Casey JR, Almudevar A. Reducing the frequency of acute otitis media by individualized care. Pediatr Infect Dis J. 2013;32(5):473-8.
Pichichero, M. E., Casey, J. R., & Almudevar, A. (2013). Reducing the frequency of acute otitis media by individualized care. The Pediatric Infectious Disease Journal, 32(5), pp. 473-8. doi:10.1097/INF.0b013e3182862b57.
Pichichero ME, Casey JR, Almudevar A. Reducing the Frequency of Acute Otitis Media By Individualized Care. Pediatr Infect Dis J. 2013;32(5):473-8. PubMed PMID: 23340550.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reducing the frequency of acute otitis media by individualized care. AU - Pichichero,Michael E, AU - Casey,Janet R, AU - Almudevar,Anthony, PY - 2013/1/24/entrez PY - 2013/1/24/pubmed PY - 2014/5/9/medline SP - 473 EP - 8 JF - The Pediatric infectious disease journal JO - Pediatr. Infect. Dis. J. VL - 32 IS - 5 N2 - OBJECTIVE: We sought to determine if use of more stringent diagnostic criteria for acute otitis media (AOM) than currently advocated by the American Academy of Pediatrics, tympanocentesis and pathogen-specific antibiotic treatment (individualized care) would result in reducing the incidence of recurrent AOM and consequent tympanostomy tube surgery. METHODS: A 5-year longitudinal, prospective study in Rochester, NY, was conducted from July 2006 to July 2011 involving 254 individualized care children. When this individualized care group developed symptoms of AOM, strict diagnostic criteria were applied and a tympanocentesis was performed. Pathogen resistance to empiric high-dose amoxicillin/clavulanate (80 mg/kg of amoxicillin component) caused a change in antibiotic to an optimized choice. Legacy controls (n = 208) were diagnosed with the same diagnostic criteria by the same physicians as the individualized care group and received the same empiric amoxicillin/clavulanate (80 mg/kg of amoxicillin component) but no tympanocentesis or change in antibiotic. Community control children (n = 1020) were diagnosed according to current American Academy of Pediatrics guidelines and treated with high-dose amoxicillin (80 mg/kg) without tympanocentesis as guideline recommended. RESULTS: 5.9% of children of the individualized care group compared with 14.4% of Legacy controls and 27.3% of community controls became otitis prone, defined as 3 episodes of AOM within a 6-month time span or 4 AOM episodes within a 12-month time span (P < 0.0001). 2.4% of the individualized care group compared with 6.3% of Legacy controls, and 14.8% of community controls received tympanostomy tubes (P < 0.0001). CONCLUSIONS: Individualized care of AOM significantly reduces the frequency of AOM and tympanostomy tube surgery. Use of strict diagnostic criteria for AOM and empiric antibiotic treatment using evidence-based knowledge of circulating otopathogens and their antimicrobial susceptibility profile also produces improved outcomes. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/23340550/Reducing_the_frequency_of_acute_otitis_media_by_individualized_care_ L2 - http://Insights.ovid.com/pubmed?pmid=23340550 DB - PRIME DP - Unbound Medicine ER -