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Clinical practice guidelines for acute otitis media in children: A systematic review and appraisal of European national guidelines

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e035343.full.pdfPublished version1.08 MBAdobe PDFView/Open
Supplemental File 1- Electronic Search Strategies .pdfSupporting information29.98 kBAdobe PDFView/Open
Supplementary File 2-Acute otitis media (AOM) guidelines in Europe.pdfSupporting information48.93 kBAdobe PDFView/Open
Supplementary File 3- National guidelines’ Level of evidence (LoE) converted to Oxford Centre for Evidence Based Medicine (OCEBM) .pdfSupporting information33.71 kBAdobe PDFView/Open
Supplementary File 4-National guidelines’ Strength of recommendation (SoR) converted to OCEBM SoR.pdfSupporting information30.93 kBAdobe PDFView/Open
Supplementary File 5-Locally defined Strength of Recommendation (SoR) for diagnostic criteria for AOM in Europe and the USA.pdfSupporting information86.82 kBAdobe PDFView/Open
Supplementary File 6-Examination tools recommended by European, American and WHO guidelines for acute otitis media (AOM) in children .pdfSupporting information28.93 kBAdobe PDFView/Open
Supplementary File 7-Investigations recommended by European, American, and WHO guidelines for acute otitis media (AOM) in children .pdfSupporting information36.66 kBAdobe PDFView/Open
Supplementary File 8-Antibiotic treatment recommended by European, American and WHO guidelines for acute otitis media (AOM) in children .pdfSupporting information79.07 kBAdobe PDFView/Open
Supplementary File 9-AGREE scores for acute otits media guidelines (AOM) in European, American, and WHO guidelines.pdfSupporting information95.2 kBAdobe PDFView/Open
Title: Clinical practice guidelines for acute otitis media in children: A systematic review and appraisal of European national guidelines
Authors: Suzuki, H
Dewez, JE
Nijman, R
Yeung, S
Item Type: Journal Article
Abstract: Objectives: To appraise European guidelines for acute otitis media (AOM) in children, including methodological quality, level of evidence and strength of recommendations (SoR), and consideration of antibiotic stewardship. Design: Systematic review of the literature Data sources: Three-pronged search of 1) Databases: Medline, Embase, Cochrane library, Guidelines International Network, and Trip Medical Database; 2) websites of European national paediatric associations and 3) contact of European experts. Data was collected between January 2017-February 2018. Eligibility criteria: National guidelines of European countries for the clinical management of AOM in children aged <16 years. Data extraction and synthesis: Data was extracted using tables constructed by the research team. Guidelines were graded using AGREE II criteria. Level of Evidence (LoE) and Strength of Recommendations (SoR) were compared. Guidelines were assessed for principles of antibiotic stewardship. Results: AOM guidelines were obtained from 17 of the 32 EU/EFTA countries. The mean AGREE II score was ≤41% across most domains. Diagnosis of AOM was based upon similar signs and symptoms. The most common indication for antibiotics was tympanic membrane perforation/otorrhoea (14/15,93%). The majority (15/17;88%) recommended a watchful waiting approach to antibiotics. Amoxicillin was the most common first-line antibiotic (14/17;82%). Recommended treatment duration varied from five to ten days. Seven countries advocated high dose (75-90mg/kg/day) and five low dose (30-60mg/kg/day) amoxicillin. Less than 60% of guidelines used a national or international scale system to rate level of evidence to support recommendations. Under half of the guidelines (7/17; 41%) referred to country-specific microbiological and antibiotic resistance data. Conclusions: Guidelines for managing AOM were similar across European countries. Guideline quality was mostly weak, and often did not refer to country-specific antibiotic resistance patterns. Co-ordinating efforts to produce a core guideline which can then be adapted by each country may help improve overall quality and contribute to tackling antibiotic resistance. Strengths and limitations of this study: • Strengths: The methodology includes the use of a comprehensive three-pronged search strategy with no language restrictions to identify guidelines from across Europe, the use of a standardized and internationally recognised guideline appraisal tool (AGREE II), the assessment of Leveles of Evidence and Strength of Recommendations, and the assessment of whether antibiotic stewardship, a key measure to reduce antimicrobial resistance (AMR), was considered. • Limitations: The review focused only on AOM without complications; guidelines for complex otitis media requiring specialist (Ear Nose Throat) input were not included. Another limitation is the consideration of whether guidelines developers used country-specific AMR patterns to assess if the recommendations of antibiotics were based on AMR data. However, there is often wide heterogeneity in terms of AMR patterns within each country.
Issue Date: 5-May-2020
Date of Acceptance: 14-Jan-2020
URI: http://hdl.handle.net/10044/1/76946
DOI: 10.1136/bmjopen-2019-035343
ISSN: 2044-6055
Publisher: BMJ Journals
Start Page: 1
End Page: 10
Journal / Book Title: BMJ Open
Volume: 10
Issue: 5
Copyright Statement: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Keywords: Europe
acute otitis media
antibiotic stewardship
children
guidelines
systematic review
1103 Clinical Sciences
1117 Public Health and Health Services
1199 Other Medical and Health Sciences
Publication Status: Published
Article Number: ARTN e035343
Online Publication Date: 2020-05-05
Appears in Collections:Department of Infectious Diseases
Faculty of Medicine