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- Title
Tympanostomy Tube Otorrhea: A Call for Action for Antibiotic Stewardship.
- Authors
Mackey, Wendy Lord
- Abstract
Background Tympanostomy tube (TT) insertion is the most common ambulatory surgical procedure performed in children in North America. Tympanostomy tube otorrhea (TTO) is the most common sequela following their placement. Twenty years of sound evidence exists documenting the superiority of ototopical antibiotics therapy (TAD) over oral antibiotics and other management options to treat TTO, and a national guideline strongly recommends their use; yet many providers will prescribe oral antibiotics versus the recommended topical option. This contributes to antibiotic resistance. The World Health Organization (2021) has declared antibiotic resistance a global health crisis. Aims and Objectives To explore the evidence regarding the efficacy of tympanostomy tube otorrhea treatment options in children with tympanostomy tubes, and research the current state of tympanostomy tube use in children. Design Integrative review. Methods Three electronic databases (OVID Medline, Scopus, and Cochrane Reviews) were searched. The search was guided by PRISMA and data collection on variables including TTO treatment options and outcomes in children with TT, adverse events of TTO treatment and general data and demographics regarding tympanostomy tube placement in children. Articles were reviewed individually for study characteristics and appraised for quality and relevance to the objectives. Results Thirty-eight studies were relevant and included in the review of the literature. TTO is a common occurrence in children who have placement of TT. All studies evaluating TTO treatment options in children found topical antibiotic otic drops (TAD) to be superior to all other treatment options including oral antibiotics, saline irrigations, topical steroid drops and a weight and watch approach. Oral antibiotics in addition to topical treatment had no significant advantage. However, TAD that included a steroid component were superior to TAD without steroid. Antibiotic resistance was not identified with TAD treatment. Studies also note caregivers were able to appropriately identify TTO, had low decisional regret following TT placement and note improved quality of life for their child and themselves. Conclusions This article provides an integrative review of the literature regarding the current state of TT in children, with a focus on TTO management highlighting the superiority of TAD over other treatment options with a sound safety profile. Clinicians have a responsibility to evaluate their practice and implement strategies to improve clinical outcomes and reduce antimicrobial misuse. This is a call to action for ORL nurses and all clinicians caring for children with TTs, to consider the evidence when to provide care.
- Subjects
DRUG efficacy; MEDICAL databases; IRRIGATION (Medicine); CONSERVATIVE treatment; ANTIMICROBIAL stewardship; MEDICAL device removal; SYSTEMATIC reviews; ORAL drug administration; STEROIDS; WORLD health; HEALTH outcome assessment; MEDICAL care costs; OTITIS media with effusion; RESPONSIBILITY; MEDICAL protocols; MIDDLE ear ventilation; DECISION making; QUALITY of life; NURSES; AMBULATORY surgery; MEDLINE; CUTANEOUS therapeutics; ADVERSE health care events; DRUG resistance in microorganisms; EMOTIONS; ANTIBIOTICS; PATIENT safety; BACTERIA; DISEASE risk factors
- Publication
ORL-Head & Neck Nursing, 2023, Vol 41, Issue 3, p7
- ISSN
1064-3842
- Publication type
Article