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Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media

Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media
Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media
Objective: To compare immediate with delayed prescribing of antibiotics for acute otitis media.
Design: Open randomised controlled trial.
Setting: General practices in south west England.
Participants: 315 children aged between 6 months and 10 years presenting with acute otitis media.
Interventions: Two treatment strategies, supported by standardised advice sheets-immediate antibiotics or delayed antibiotics (antibiotic prescription to be collected at parents' discretion after 72 hours if child still not improving).
Main outcome measures: Symptom resolution, absence from school or nursery, paracetamol consumption.
Results: On average, symptoms resolved after 3 days. Children prescribed antibiotics immediately had shorter illness (-1.1 days (95% confidence interval -0.54 to -1.48)), fewer nights disturbed (-0.72 (-0.30 to -1.13)), and slightly less paracetamol consumption (-0.52 spoons/day (-0.26 to -0.79)). There was no difference in school absence or pain or distress scores since benefits of antibiotics occurred mainly after the first 24 hours-when distress was less severe. Parents of 36/150 of the children given delayed prescriptions used antibiotics, and 77% were very satisfied. Fewer children in the delayed group had diarrhoea (14/150 (9%) v 25/135 (19%), ?2=5.2, P=0.02). Fewer parents in the delayed group believed in the effectiveness of antibiotics and in the need to see the doctor with future episodes.
Conclusion: Immediate antibiotic prescription provided symptomatic benefit mainly after first 24 hours, when symptoms were already resolving. For children who are not very unwell systemically, a wait and see approach seems feasible and acceptable to parents and should substantially reduce the use of antibiotics for acute otitis media.
0959-8138
336-342
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gould, Clare
058d7307-9b42-4f85-b02e-7e3a37d9af67
Williamson, Ian
12381296-edbf-4ac5-969b-dcb559c22f27
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Warner, Greg
72005519-1aa0-42da-b370-7ebd99792539
Dunleavey, Joan
48a52b61-973f-4efc-a2ac-ad4bb7c00ceb
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gould, Clare
058d7307-9b42-4f85-b02e-7e3a37d9af67
Williamson, Ian
12381296-edbf-4ac5-969b-dcb559c22f27
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Warner, Greg
72005519-1aa0-42da-b370-7ebd99792539
Dunleavey, Joan
48a52b61-973f-4efc-a2ac-ad4bb7c00ceb

Little, Paul, Gould, Clare, Williamson, Ian, Moore, Michael, Warner, Greg and Dunleavey, Joan (2001) Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ, 322 (7282), 336-342. (doi:10.1136/bmj.322.7282.336).

Record type: Article

Abstract

Objective: To compare immediate with delayed prescribing of antibiotics for acute otitis media.
Design: Open randomised controlled trial.
Setting: General practices in south west England.
Participants: 315 children aged between 6 months and 10 years presenting with acute otitis media.
Interventions: Two treatment strategies, supported by standardised advice sheets-immediate antibiotics or delayed antibiotics (antibiotic prescription to be collected at parents' discretion after 72 hours if child still not improving).
Main outcome measures: Symptom resolution, absence from school or nursery, paracetamol consumption.
Results: On average, symptoms resolved after 3 days. Children prescribed antibiotics immediately had shorter illness (-1.1 days (95% confidence interval -0.54 to -1.48)), fewer nights disturbed (-0.72 (-0.30 to -1.13)), and slightly less paracetamol consumption (-0.52 spoons/day (-0.26 to -0.79)). There was no difference in school absence or pain or distress scores since benefits of antibiotics occurred mainly after the first 24 hours-when distress was less severe. Parents of 36/150 of the children given delayed prescriptions used antibiotics, and 77% were very satisfied. Fewer children in the delayed group had diarrhoea (14/150 (9%) v 25/135 (19%), ?2=5.2, P=0.02). Fewer parents in the delayed group believed in the effectiveness of antibiotics and in the need to see the doctor with future episodes.
Conclusion: Immediate antibiotic prescription provided symptomatic benefit mainly after first 24 hours, when symptoms were already resolving. For children who are not very unwell systemically, a wait and see approach seems feasible and acceptable to parents and should substantially reduce the use of antibiotics for acute otitis media.

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Published date: 2001

Identifiers

Local EPrints ID: 24394
URI: http://eprints.soton.ac.uk/id/eprint/24394
ISSN: 0959-8138
PURE UUID: 36e9310c-c66d-489e-9ed8-43c0b23f9836
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 31 Mar 2006
Last modified: 23 Jul 2022 01:54

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Contributors

Author: Paul Little
Author: Clare Gould
Author: Ian Williamson
Author: Michael Moore ORCID iD
Author: Greg Warner
Author: Joan Dunleavey

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