Document Detail


Implications of the AHRQ evidence report on acute otitis media.
MedLine Citation:
PMID:  11700439     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To familiarize otolaryngologists with the Agency for Healthcare Research and Quality (AHRQ) Evidence Report on Acute Otitis Media (AOM) that reviews the natural history and role of antibiotics in management. The report, by the Southern California Evidence-Based Practice Center (SC-EPC), is the most recent of 15 literature syntheses published by the AHRQ. DATA SOURCES: MEDLINE (1966 to present), Cochrane Library, EMBASE, BIOSIS, HealthSTAR, and other computerized databases; manual reference search of proceedings, articles, reports, and guidelines. STUDY SELECTION: Randomized trials and cohort studies relevant to the natural history of AOM and the efficacy of antimicrobial therapy. AOM was defined by the 11-member technical expert panel (including 2 authors, RMR and MLC) as middle-ear effusion with the rapid onset of signs or symptoms of middle ear inflammation. DATA EXTRACTION: Two physician reviewers at the Southern California Evidence-Based Practice Center independently rated the articles and extracted data. DATA SYNTHESIS: Children receiving placebo or no antimicrobial had a pooled clinical success rate of 81% at 1 to 7 days (95% CI, 72% to 90%), with no increase in suppurative complications when followed closely. Amoxicillin or ampicillin increased the absolute success rate by 12.3% (95% CI, 2.8% to 21.8%) in 5 studies pooled using random effects meta-analysis. The antimicrobial benefit was robust to sensitivity analysis. In contrast, success rates were not influenced by the choice or duration of therapy. CONCLUSIONS: The AHRQ report emphasizes middle-ear effusion as a preeminent criteria for AOM diagnosis and provides extensive evidence tables on natural history and antimicrobial impact. About 8 children must receive antibiotics to avoid 1 clinical failure, but children younger than age 2 years or with severe symptoms may benefit more. The report is a starting point for organizations seeking to develop AOM guidelines, performance measures, and other quality improvement tools.
Authors:
R M Rosenfeld; M L Casselbrant; M T Hannley
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery     Volume:  125     ISSN:  0194-5998     ISO Abbreviation:  Otolaryngol Head Neck Surg     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-11-08     Completed Date:  2001-12-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8508176     Medline TA:  Otolaryngol Head Neck Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  440-8; discussion 439     Citation Subset:  IM    
Affiliation:
Department of Otolaryngology, SUNY Health Science Center at Brooklyn, NY, USA. richrosenfeld@msn.com
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Anti-Bacterial Agents / therapeutic use*
Child
Child, Preschool
Evidence-Based Medicine*
Humans
Infant
Otitis Media / complications,  therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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