The content of these recommendations is what made the rounds in various news outlets – the first begrudging revelations that antibiotics are possibly unnecessary for many of acute otitis media. This isn’t news to us, of course, but it’s entertaining to see the precise moment the Rock of Gibraltar starts to make its slow course corrections.
As far as clinical policy statements go, however, this is beautifully constructed. For every actionable statement, these authors offer a concise summary of the benefits, harms, value judgements, intentional vagueness, patient preferences, and exclusions. Whether I agree with the hairs they split on each recommendation is almost overwhelmed by how pleasant it is to understand the basis of their reasoning.
My big irritation: their implication that symptom severity or temperatures greater than 102.2F are somehow specific for bacterial disease more likely to benefit from antibiotics. Odd – or am I missing a notable piece of literature? Please point it out if so!
The other new item of interest is the “Strong Recommendation” for analgesic treatment in cases of AOM. Thank goodness!
“The Diagnosis and Management of Acute Otitis Media”
www.ncbi.nlm.nih.gov/pubmed/23439909