Acceptability and feasibility Antibiotic treatment for Chronic Suppurative Otitis Media CSOM
8.4.1 Evidence and summary of findings
One systematic review identiied two RCTs that included arms which compared the efectiveness of topical antiseptics versus no treatment or placebo [Acuin, 2007]. here was low quality evidence that there is no statistically signiicant diference in the rates of treatment failure between topical antiseptic and placebo or no treatment see GRADE table A7.23 . However, both studies were underpowered and had some methodological laws. In the irst RCT, 60 children with otorrhoea in a hospital clinic in South Africa compared aluminium acetate solutions of varying concentrations 13.00, 3.25, and 1.30 [horp, 2000]. he most dilute solution was considered to be inactive. he RCT found no signiicant diference in dry ears ater 2 weeks 21 out of 26 patients 81 of ears with 13.00 aluminium acetate versus 15 out of 20 patients 75 with 3.25 aluminium acetate versus 5 out of 10 patients 50 with 1.30 aluminium acetate; p = 0.18. However, this study may have lacked power to detect a clinically signiicant diference. he second RCT included 134 children 180 ears and compared ive interventions: ear cleansing alone, ear cleansing plus topical antiseptic, ear cleansing plus topical antiseptic plus topical antibiotics plus corticosteroid, ear cleansing plus topical anti- septic plus topical antibiotics plus corticosteroid plus oral antibiotic clindamycin, and no treatment [Eason, 1986]. It found no signiicant diference between ear cleans- ing plus topical antiseptic boric acid 2 4 times daily and ear cleansing alone in the proportion of children with no change in otoscopic appearance ater 6 weeks 43 children, 58 ears: 12 out of 32 [38] with topical antiseptic versus 13 out of 26 [50] with ear cleansing alone; OR 0.61, 95 CI 0.22 to 1.71.8.4.2 Benefits and risks
Benefits he studies show that there is no added value in using topical antiseptics as they do not reduce ear discharge compared to placebo. herefore, they do not have a beneit in treating CSOM. Risks he two RCTs gave no information on adverse efects where topical antiseptics were used compared to placebo. However, in one systematic review of topical antiseptics versus topical antibiotics, there was increased adverse events e.g. ear pain, irritation, and bleeding on ear mopping combined; 30 out of 206 [14.6] with boric acid versus 17 out of 210 [8.1] with ciproloxacin; Absolute Risk 6.5, 95 CI 0.3 to 12.7 [Macfadyen, 2005]. One study also reported cochlear and vestibular otototoxity at high doses [Perez, 2000].Parts
» Hospital Care WHO evidence 0
» Objectives of the recommendations
» Management of conflict of interest
» Defining the scope Methodology and process
» Evidence retrieval and synthesis process
» Consensus building and external peer review
» Review and update of the recommendations
» Proposed subsidiary products Implementation of the recommendations
» Implementation of the recommendations
» National adaptation and implementation
» Management of neonatal jaundice Empirical antibiotics for suspected neonatal sepsis
» Antibiotic treatment for non-severe pneumonia with no wheeze
» Inhaled salbutamol for treatment of acute wheezeasthma and
» Antibiotics for treatment of acute otitis media
» Clinical signs for detection of hypoxaemia in children
» Oxygen delivery methods Criteria for starting and stopping oxygen therapy
» Evidence and summary of findings
» Benefits and risks Acceptability and feasibility
» Evidence and summary of findings Benefits and risks
» Acceptability and feasibility Management of neonatal jaundice
» Benefits and risks Head or whole body cooling in management of hypoxic ischaemic
» Acceptability and feasibility Head or whole body cooling in management of hypoxic ischaemic
» Evidence and summary of recommendations
» Acceptability and feasibility Kangaroo Mother Care
» Benefits and risks Prevention of hypothermia immediately after birth in low birth
» Acceptability and feasibility Prevention of hypothermia immediately after birth in low birth
» Benefits and risks Antibiotic treatment for non-severe pneumonia with wheeze
» Acceptability and feasibility Antibiotic treatment for non-severe pneumonia with wheeze
» Benefits and risks Antibiotic treatment for non-severe pneumonia with no wheeze
» Acceptability and feasibility Antibiotic treatment for non-severe pneumonia with no wheeze
» Benefits and risks Antibiotics treatment for severe pneumonia
» Acceptability and feasibility Antibiotics treatment for severe pneumonia
» Evidence and summary of findings Benefits and risks Acceptability and feasibility
» Acceptability and feasibility Salbutamol for treatment of acute wheezeasthma and
» Acceptability and feasibility Antibiotics for treatment of acute bacterial meningitis
» Benefits and risks Antibiotic treatment for Acute Otitis Media AOM
» Acceptability and feasibility Antibiotic treatment for Chronic Suppurative Otitis Media CSOM
» Benefits and risks Topical steroids for treatment of Chronic Suppurative Otitis Media
» Acceptability and feasibility Topical steroids for treatment of Chronic Suppurative Otitis Media
» Benefits and risks Antibiotic treatment for Typhoid Fever
» Acceptability and feasibility: Antibiotic treatment for Typhoid Fever
» Benefits and risks Antibiotics use in the management of severe acute malnutrition
» Acceptability and feasibility Antibiotics use in the management of severe acute malnutrition
» Acceptability and feasibility: Oxygen therapy in treatment of hypoxaemia
» Acceptability and feasibility Oxygen therapy delivery methods
» Benefits and risks Criteria for starting and stopping oxygen therapy
» Acceptability and feasibility Criteria for starting and stopping oxygen therapy
» Benefits and risks Sublingual administration of sugar in treatment of hypoglycaemia
» Acceptability and feasibility Sublingual administration of sugar in treatment of hypoglycaemia
» Benefits and risks Choice of intravenous fluids for resuscitation and maintenance in
» Vitamin K prophylaxis in newborns
» Skin-to-skin contact in the first hour of life
» Management of neonatal jaundice
» Kangaroo Mother Care Outline of the research gaps
» Prevention of hypothermia immediately after birth in VLBW infants
» Management of children with non-severe pneumonia and wheeze
» Antibiotics for severe pneumonia
» Antibiotics for very severe pneumonia
» Treatment of non-severe pneumonia
» Problems of the neonate and young infant
» Fever Severe malnutrition Hospital Care WHO evidence 0
» Children with HIVAIDS Hospital Care WHO evidence 0
» Common surgical conditions Hospital Care WHO evidence 0
» Supportive care Hospital Care WHO evidence 0
» Monitoring the child’s progress
» Counselling and discharge from hospital
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