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AMERICAN ACADEMY OF PEDIATRICS:
Subcommittee on Management of Acute Otitis Media
Diagnosis and Management of Acute Otitis Media
Pediatrics 2004; 113: 1451-1465 [Abstract] [Full text] [PDF]
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[Read P3R] This guideline could as well have suggested initial observation with analgesia for all
Atle Klovning   (22 June 2004)

This guideline could as well have suggested initial observation with analgesia for all 22 June 2004
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Atle Klovning,
Associate Professor/Family Physician
University of Bergen

Send letter to journal:
Re: This guideline could as well have suggested initial observation with analgesia for all

atle.klovning{at}isf.uib.no Atle Klovning

I think this clinical practice guideline (CPG) reflects an American prescribing bias.

There are several problems with the methods used:

1. The levels of evidence are not the ones widely used today, A, B, C and D, as defined in http://www.cebm.net/levels_of_evidence.asp

2. It references an outdated Cochrane review, which now is updated (1), and more restrictive to antibiotics in areas where the mastoiditis rates are low.

3. It does not cite Clinical Evidence (www.clinicalevidence.com), which also is more restrictive to antibiotics.

4. I do not understand how the proposed algorithm in Fig. 1 could be derived from data in table 5, which shows non-significant differences in 8 of 11 outcomes when comparing initial antibacterial therapy with initial observation. Further, there is a 16% risk of side-effects.

Implementing this guideline in my country would raise the prescription rate. As I see it, this CPG could as well have suggested initial observation with analgesia for all.

Reference

1. Glasziou PP, Del Mar CB, Sanders SL, Hayem M. Antibiotics for acute otitis media in children (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd.