Review - Reviewer's Assessment

1. Short summary / abstract
This research compares immediate antibiotic treatment in childhood acute otitis media, with a wait and see approach, in which parents could collect an antibiotic prescription after 72 hours. The study found that, for most children who are not very unwell systemically, a wait and see approach is acceptable to parents and resulted in a significant reduction in antibiotic prescriptions. Children with vomiting, higher temperature or recurrent otitis media benefited more from immediate antibiotics.

2. What question is the document addressing?
Is a delayed antibiotic prescribing strategy for childhood acute otitis media as good as immediate antibiotics, and is it acceptable to parents?

3. Type of study
A randomised study of 2 treatment strategies in acute otitis media - immediate antibiotics versus delayed antibiotics.

4. Methods valid & appropriate?

This was a pragmatic study based in primary care which tested to commonly used management strategies.

5. Results / recommendations reliable?
The main outcomes on symptom relief and prescriptions collected are reliable. The sample size was not large enough for the secondary outcomes to be completely reliable. The authors do suggest that further studies are needed to estimate the benefits of treatment in patients with higher temperature, vomiting and recurrent otitis media.

6. Any major problems and biases?
Is it possible that children with more severe otitis media may not have been enrolled by clinicians?

7. Any other important / relevant studies which confirm or contradict?
1. Marchetti F, Ronfani L, Nibali SC, Tamburlini G. Delayed prescription may reduce the use of antibiotics for acute otitis media. A prospective observational study in primary care. Arch Pediatr Adolesc Med 2005;159:679-84.
2. McCormick DP, Chonmaitree T, Pittman C, Saeed K, Friedman NR, Uchida T, Baldwin CD. Nonsevere acute otitis media: a clinical trial comparing outcomes of watchful waiting versus immediate antibiotic treatment. Pediatrics 2005:115(6):1455-65.
3. Arroll B, Goodyear-Smith F, Thomas DR, Kerse N. Delayed antibiotic prescriptions: What are the experiences and attitudes of physicians and patients. J Fam Pract 2002:51(11):954-59.

8. Keywords
Otitis media primary care antibiotics delayed prescription management treatment

Reviewer's Details:

Name:Dr Cliodna McNulty
Post:Head, Health Protection Agency Primary Care Unit
(Society / Organisation / Advisory Committee):
Higher Education Academy
British Medical Association
Association of Clinical Pathologists
British Society for Antimicrobial Chemotherapy
Assocaition of Medical Microbiologists
SACAR Public Education Sub-Group

*** Note: These are the views of a professional expert rather than an official statement from his or her society, organisation or advisory committee.

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