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- Title
Errors by pediatricians in characterizing treated otitis media cases as failures
- Authors
Poole, Michael D.; Pereira, Kevin D.
- Abstract
Objectives: When clinicians mistakenly catagorize cases of AOM treated with appropriate antibiotics as treatment failures, they often recommend therapies that are inappropriate or less efficacious. We sought to understand and describe the reasons why primary clinicians characterize antibiotics prescribed for cases of acute otitis media (AOM) as being ineffective at a much higher rate than the actual bacteriologic failure rates for guideline-recommended antibiotics (eg, amoxicillin or amoxicillin-clavulanate).Methods: Prospective critical observation and video-otoscopy of cases of AOM recently deemed treatment failures by pediatricians, combined with interviews with the pediatricians.Results: We identified 4 major types of errors that were repetitively made. Two were due to inaccurate perceptions of data: (1) misunderstanding that new infection is much more common than relapse/failure in patients with AOM who recently finished a guideline antibiotic, and (2) inaccurate perceptions about the relative bacteriologic efficacy of various agents. There were 2 additonal types of errors related to wrong diagnoses and suboptimal otoscopic skill: (1) the correct initial diagnosis was either absence of effusion or OM with effusion (OME), not AOM, so that antibiotics had no appreciable effect, and (2) after completing therapy, OME was present (with or without residual TM inflammation) but the degree of improvement was appropriate and it was no longer AOM.Conclusions: These errors in management help explain why, even though clinicians may be generally knowledgable about antibiotic guidelines for AOM, they may recommend relatively inappropriate options such as less efficacious antibiotics or premature surgical consultation. Educational efforts directed at these errors should improve OM management.
- Subjects
OTITIS media; ANTIBIOTICS; ANTI-infective agents; MIDDLE ear diseases
- Publication
Otolaryngology-Head & Neck Surgery, 2004, Vol 131, Issue 2, pP219
- ISSN
0194-5998
- Publication type
Abstract
- DOI
10.1016/j.otohns.2004.06.421