Downloaded from http://ep.bmj.com/ on July 18, 2015 - Published by group.bmj.com
Guideline review Correction notice This paper has been amended since it was published Online First. The author order was incorrect, Somaiah Siddiq is the first author of this manuscript. Competing interests None.
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Provenance and peer review Commissioned; externally peer reviewed.
5
REFERENCES 1 Lieberthal AS, Chonmaitree T, Ganiats TG, et al. The diagnosis and management of acute otitis media. Pediatrics 2013;131: e964–99. 2 NICE Clinical Knowledge Summaries (CKS)—Otitis media— Acute. http://cks.nice.org.uk/otitis-media-acute#!topicsummary 3 NICE. Respiratory tract infections: antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract
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infections in adults and children in primary care (NICE guideline). Clinical guideline 69. National Institute for Health and Clinical Excellence. 2008a. http://www.nice.org.uk SIGN. Diagnosis and management of childhood otitis media in primary care. A national clinical guidance. February 2013. Principi N, Baggi E, Esposito S. Prevention of acute otitis media using currently available vaccines. Future Microbiol 2012;7:457–65. Department of Health. Gateway reference 00157. https://www. gov.uk/government/uploads/system/uploads/attachment_data/file/ 207008/130613_Flu_Letter_v_29_Gateway_GW_signed.pdf San LB. Management of acute otitis media in afebrile neonates. Pediatr Ann 2012;41:225–8. Block SL. Improving the diagnosis of acute otitis media: “Seeing is believing”. Pediatr Ann 2013;42:485–90.
American Academy of Otolaryngology: head and neck surgery foundation clinical practice guideline on acute otitis externa 2014 This American guideline updates previous 2006 recommendations providing guidance for primary care and specialist clinicians for treating children of 2 years and older with acute otitis externa (AOE): a diffuse inflammation of the external ear canal ±pinna and tympanic membrane.1 2 KEY POINTS: WHAT SHOULD I BE DOING? ▸ Distinguish diffuse AOE from other causes of otalgia and otorrhoea, for example, dermatitis (inflammatory, contact, allergic), viral infections, furunculosis and referred pain from other sites ▸ Appropriately assess pain and treat with analgesia such as non-steroidal anti-inflammatories. There are no specific indications for using anaesthetic ear drops, which may mask disease progression ▸ Prescribe topical ear drops for uncomplicated AOE for at least 7 days. Topical preparations include antibiotics (aminoglycosides, polymyxin B, quinolones), steroids (hydrocortisone, dexamethasone) and low-pH antiseptics, for example, acetic acid. There is no good evidence to recommend one topical ear drop from another or monotherapy versus combination treatment ▸ If there is perforation of the tympanic membrane (iatrogenic or disease related), prescribe non-ototoxic ear drops ▸ Provide education to patients and families to help delivery of drops and maximise adherence ▸ Do not prescribe systemic antibiotics as initial therapy, although these may be needed in patients with underlying disease, for example, diabetes, HIV and other immunosuppression, where there is a risk of necrotising otitis externa
▸ Reassess after 48–72 h if there is no response to initial treatment. Philippa Prentice Correspondence to Dr Philippa Prentice, Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, UK; [email protected]
Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Prentice P. Arch Dis Child Educ Pract Ed 2015;100:197. Received 7 October 2014 Accepted 8 October 2014
▸ http://dx.doi.org/10.1136/edpract-2013-305550 Arch Dis Child Educ Pract Ed 2015;100:197. doi:10.1136/archdischild-2014-307676
REFERENCES 1 Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa executive summary. Otolaryngol Head Neck Surg 2014;150:161–8. 2 Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2014;150(1 Suppl):S1–24.
Siddiq S, et al. Arch Dis Child Educ Pract Ed 2015;100:193–197. doi:10.1136/archdischild-2013-305550
197
Downloaded from http://ep.bmj.com/ on July 18, 2015 - Published by group.bmj.com
American Academy of Otolaryngology: head and neck surgery foundation clinical practice guideline on acute otitis externa 2014 Philippa Prentice Arch Dis Child Educ Pract Ed 2015 100: 197
doi: 10.1136/archdischild-2014-307676 Updated information and services can be found at: http://ep.bmj.com/content/100/4/197
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This article cites 2 articles, 2 of which you can access for free at: http://ep.bmj.com/content/100/4/197#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Ear, nose and throat/otolaryngology (38) Otitis (8) Pain (neurology) (91) Drugs: infectious diseases (104) Child health (300) Immunology (including allergy) (171) Competing interests (ethics) (43) Dermatology (77) HIV/AIDS (8) Injury (43) Journalology (53) Oncology (89) Sexual health (33) Trauma (42)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Guideline review Correction notice This paper has been amended since it was published Online First. The author order was incorrect, Somaiah Siddiq is the first author of this manuscript. Competing interests None.
4
Provenance and peer review Commissioned; externally peer reviewed.
5
REFERENCES 1 Lieberthal AS, Chonmaitree T, Ganiats TG, et al. The diagnosis and management of acute otitis media. Pediatrics 2013;131: e964–99. 2 NICE Clinical Knowledge Summaries (CKS)—Otitis media— Acute. http://cks.nice.org.uk/otitis-media-acute#!topicsummary 3 NICE. Respiratory tract infections: antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract
6
7 8
infections in adults and children in primary care (NICE guideline). Clinical guideline 69. National Institute for Health and Clinical Excellence. 2008a. http://www.nice.org.uk SIGN. Diagnosis and management of childhood otitis media in primary care. A national clinical guidance. February 2013. Principi N, Baggi E, Esposito S. Prevention of acute otitis media using currently available vaccines. Future Microbiol 2012;7:457–65. Department of Health. Gateway reference 00157. https://www. gov.uk/government/uploads/system/uploads/attachment_data/file/ 207008/130613_Flu_Letter_v_29_Gateway_GW_signed.pdf San LB. Management of acute otitis media in afebrile neonates. Pediatr Ann 2012;41:225–8. Block SL. Improving the diagnosis of acute otitis media: “Seeing is believing”. Pediatr Ann 2013;42:485–90.
American Academy of Otolaryngology: head and neck surgery foundation clinical practice guideline on acute otitis externa 2014 This American guideline updates previous 2006 recommendations providing guidance for primary care and specialist clinicians for treating children of 2 years and older with acute otitis externa (AOE): a diffuse inflammation of the external ear canal ±pinna and tympanic membrane.1 2 KEY POINTS: WHAT SHOULD I BE DOING? ▸ Distinguish diffuse AOE from other causes of otalgia and otorrhoea, for example, dermatitis (inflammatory, contact, allergic), viral infections, furunculosis and referred pain from other sites ▸ Appropriately assess pain and treat with analgesia such as non-steroidal anti-inflammatories. There are no specific indications for using anaesthetic ear drops, which may mask disease progression ▸ Prescribe topical ear drops for uncomplicated AOE for at least 7 days. Topical preparations include antibiotics (aminoglycosides, polymyxin B, quinolones), steroids (hydrocortisone, dexamethasone) and low-pH antiseptics, for example, acetic acid. There is no good evidence to recommend one topical ear drop from another or monotherapy versus combination treatment ▸ If there is perforation of the tympanic membrane (iatrogenic or disease related), prescribe non-ototoxic ear drops ▸ Provide education to patients and families to help delivery of drops and maximise adherence ▸ Do not prescribe systemic antibiotics as initial therapy, although these may be needed in patients with underlying disease, for example, diabetes, HIV and other immunosuppression, where there is a risk of necrotising otitis externa
▸ Reassess after 48–72 h if there is no response to initial treatment. Philippa Prentice Correspondence to Dr Philippa Prentice, Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, UK; [email protected]
Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Prentice P. Arch Dis Child Educ Pract Ed 2015;100:197. Received 7 October 2014 Accepted 8 October 2014
▸ http://dx.doi.org/10.1136/edpract-2013-305550 Arch Dis Child Educ Pract Ed 2015;100:197. doi:10.1136/archdischild-2014-307676
REFERENCES 1 Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa executive summary. Otolaryngol Head Neck Surg 2014;150:161–8. 2 Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg 2014;150(1 Suppl):S1–24.
Siddiq S, et al. Arch Dis Child Educ Pract Ed 2015;100:193–197. doi:10.1136/archdischild-2013-305550
197
Downloaded from http://ep.bmj.com/ on July 18, 2015 - Published by group.bmj.com
American Academy of Otolaryngology: head and neck surgery foundation clinical practice guideline on acute otitis externa 2014 Philippa Prentice Arch Dis Child Educ Pract Ed 2015 100: 197
doi: 10.1136/archdischild-2014-307676 Updated information and services can be found at: http://ep.bmj.com/content/100/4/197
These include:
References Email alerting service
Topic Collections
This article cites 2 articles, 2 of which you can access for free at: http://ep.bmj.com/content/100/4/197#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Ear, nose and throat/otolaryngology (38) Otitis (8) Pain (neurology) (91) Drugs: infectious diseases (104) Child health (300) Immunology (including allergy) (171) Competing interests (ethics) (43) Dermatology (77) HIV/AIDS (8) Injury (43) Journalology (53) Oncology (89) Sexual health (33) Trauma (42)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
