PubMed · 10523231
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T H Baron. 1999-10-19. Biliary sludge.. https://doi.org/10.7326/0003-4819-131-8-199910190-00020
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Sinusitis is a major cause of illness in the USA, and represents a substantial economic burden. Treatment of this condition usually involves antibiotics and, where there is a strong suspicion of bacterial etiology, has a high rate of success. Accurate diagnosis depends upon clinical assessment, but only four specific symptoms have been shown to be independent predictors of sinusitis. Other diagnostic approaches such as analysis of a microbiological sample must be considered in cases failing initial treatment. The main factors in choosing antibiotic therapy are the likely infecting pathogens, bacterial antibiotic resistance and antibiotics' pharmacological profiles. Accurate diagnosis and careful consideration when choosing therapy for sinusitis will optimise the chances of achieving an early cure.
OBJECTIVE: To compare the outcome of patients with recurrent acute otitis media (AOM) treated either with amoxicillin or with azithromycin. METHODS: This prospective, controlled, and randomized study, compares the outcome of 71 patients with recurrent AOM treated with azithromycin (31 patients) or amoxicillin (40 patients) for the prevention of AOM. azithromycin was given at a dose of 10 mg/kg once a week, whereas amoxicillin was administered daily as a single intake of one third of the therapeutic dosage (20 mg/kg per day). All treatments were prescribed for 3 months. Both groups were homogeneous with regard to the currently accepted predisposing factors of recurrent AOM. Mean age of children was 35.3 months, and average follow-up was 11.5 months. The treatment was considered effective when the number of episodes of AOM dropped to less than 50% after the prophylaxis. RESULTS: Patients in the azithromycin group had a clinical response to prophylaxis (80.6%) comparable to those treated with amoxicillin (89.5%) (P=0.300). The incidence of adverse effects was similar in both groups. CONCLUSION: According to these results, a prophylaxis with azithromycin is as useful as amoxicillin to prevent recurrent AOM.
The observation option for acute otitis media (AOM) refers to deferring antibiotic treatment of selected children for up to 3 days, during which time management is limited to analgesics and symptomatic relief. With appropriate follow-up complications are not increased, and clinical outcomes compare favorably with routine initial antibiotic therapy. Although used commonly in the Netherlands and certain Scandinavian countries, this approach has not gained wide acceptance in Europe and the United States. This article describes an evidence-based toolkit developed by the New York Region Otitis Project for judicious use of the observation option. The toolkit is not intended to endorse the observation option as a preferred method of management, nor is it intended as a rigid practice guideline to supplant clinician judgement. Rather, it presents busy clinicians with the tools needed to implement the observation option in everyday patient care should they so desire.