Wait-and-see prescription for the treatment of acute otitis media: A randomized controlled trial

David M. Spiro, Khoon Yen Tay, Donald H. Arnold, James D. Dziura, Mark Douglas Baker, Eugene D. Shapiro

Research output: Contribution to journalArticle

Abstract

Context: Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed for children. Previous trials that have evaluated a "wait-and-see prescription" (WASP) for antibiotics, with which parents are asked not to fill the prescription unless the child either is not better or is worse in 48 hours, have excluded children with severe AOM. None of these trials were conducted in an emergency department. Objectives: To determine whether treatment of AOM using a WASP significantly reduces use of antibiotics compared with a "standard prescription" (SP) and to evaluate the effects of this intervention on clinical symptoms and adverse outcomes related to antibiotic use. Design, Setting, and Patients: A randomized controlled trial conducted between July 12, 2004, and July 11, 2005. Children with AOM aged 6 months to 12 years seen in an emergency department were randomly assigned to receive either a WASP or an SP. All patients received ibuprofen and otic analgesic drops for use at home. A research assistant, blinded to group assignment, conducted structured phone interviews 4 to 6, 11 to 14, and 30 to 40 days after enrollment to determine outcomes. Main Outcome Measures: Filling of the antibiotic prescription and clinical course. Results: Overall, 283 patients were randomized either to the WASP group (n=138) or the SP group (n=145). Substantially more parents in the WASP group did not fill the antibiotic prescription (62% vs 13%; P

Original languageEnglish (US)
Pages (from-to)1235-1241
Number of pages7
JournalJournal of the American Medical Association
Volume296
Issue number10
DOIs
StatePublished - Sep 13 2006
Externally publishedYes

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Otitis Media
Prescriptions
Randomized Controlled Trials
Anti-Bacterial Agents
Therapeutics
Hospital Emergency Service
Parents
Ibuprofen
Ear
Analgesics
Outcome Assessment (Health Care)
Interviews

ASJC Scopus subject areas

  • Medicine(all)

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Wait-and-see prescription for the treatment of acute otitis media : A randomized controlled trial. / Spiro, David M.; Tay, Khoon Yen; Arnold, Donald H.; Dziura, James D.; Baker, Mark Douglas; Shapiro, Eugene D.

In: Journal of the American Medical Association, Vol. 296, No. 10, 13.09.2006, p. 1235-1241.

Research output: Contribution to journalArticle

Spiro, David M. ; Tay, Khoon Yen ; Arnold, Donald H. ; Dziura, James D. ; Baker, Mark Douglas ; Shapiro, Eugene D. / Wait-and-see prescription for the treatment of acute otitis media : A randomized controlled trial. In: Journal of the American Medical Association. 2006 ; Vol. 296, No. 10. pp. 1235-1241.
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