Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed for children in the United States. Previous trials evaluating an optional antibiotic prescription are limited and have significant limitations. None have evaluated an optional prescription in the urgent care setting. We conducted a randomized, controlled trial in an urban emergency department in which children aged 6 months to 12 years diagnosed with AOM were randomly assigned a "wait-and-see prescription" (WASP) or a "standard treatment prescription" (STP). Structured phone interviews were conducted 4-6, 11-14, and 30-40 days after enrollment to determine the proportion of each group that filled the antibiotic prescription and outcomes related to the clinical course. Substantially more parents in the WASP group (N=138) did not fill the antibiotic prescription compared to the STP group (N=145) (62% vs. 13%; P<0.001). There were no statistically significant differences between the groups in the frequency of subsequent fever, otalgia or unscheduled visits for medical care. Within the WASP group, both fever (OR = 4.0, 95% confidence interval, 1.7-9.5) and otalgia (OR = 4.5, 95% confidence interval, 1.7-11.5) were associated with filling the prescription. The WASP approach substantially reduced unnecessary use of antibiotics in children and is a reasonable alternative to routine use of antimicrobials for treatment of AOM.
| Identifer | oai:union.ndltd.org:YALE_med/oai:ymtdl.med.yale.edu:etd-06282006-144523 |
| Date | 15 November 2006 |
| Creators | Tay, Khoon-Yen Elisa |
| Contributors | David Spiro |
| Publisher | Yale University |
| Source Sets | Yale Medical student MD Thesis |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://ymtdl.med.yale.edu/theses/available/etd-06282006-144523/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to Yale School of Medicine or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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