Characteristics of children with refractory acute otitis media treated at the pediatric emergency department
| Autor: | Marie-Claude Quintal, Jacob Pitaro, Annie Lapointe, Sofia Waissbluth, Anthony Abela |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty medicine.medical_treatment Myringotomy 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Clavulanic acid medicine Humans 030223 otorhinolaryngology Child Retrospective Studies rhinorrhea business.industry Infant Retrospective cohort study General Medicine Guideline Amoxicillin Middle Ear Ventilation Anti-Bacterial Agents Otitis Media Otorhinolaryngology Child Preschool Pediatrics Perinatology and Child Health Acute Disease Practice Guidelines as Topic Ceftriaxone Etiology Female medicine.symptom business Emergency Service Hospital medicine.drug |
| Zdroj: | International journal of pediatric otorhinolaryngology. 116 |
| ISSN: | 1872-8464 |
| Popis: | Introduction Refractory acute otitis media (rAOM) is defined as the persistence of signs and symptoms of AOM for more than 48 to 72 hours after the initiation of antibiotic treatment. These patients are often referred to the pediatric emergency department (PED). We sought to study rAOM cases referred to our PED, and to evaluate their clinical characteristics and response to our local management guidelines. Methods A retrospective chart review of all children treated for rAOM between 1/2012-3/2014 was performed. Data recorded included demographics, clinical presentation, antibiotic treatments, need for surgery, and culture results. Results A total of 255 patients were included with a mean age of 19 months. Prior to admission, all the children had received at least one course of antibiotics. Amoxicillin was the most common first-line antibiotic prescribed while amoxicillin-clavulanic acid was the most common second and third-line antibiotic given. Intravenous ceftriaxone was the treatment administered at the PED. Myringotomy and pressure equalizing tube (PET) insertion were required in 60% of cases. Middle ear cultures (55 ears) were positive for Streptococcus pneumoniae in two, and Moraxella catarrhalis in only one culture. There were no differences between the mean age of children who had PET insertion and those who did not with regards to fever, rhinorrhea, and preschool or school attendance. Children presenting with otorrhea were less likely to undergo surgery (P = 0.013). Conclusions This is the first study evaluating the established local practice guideline with regards to clinical characteristics and need for surgical management. We showed that myringotomy and PET insertion due to antibiotic failure is commonly performed for cases of rAOM. The majority of the middle ear cultures were sterile. |
| Databáze: | OpenAIRE |
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