Date of Award

11-15-2006

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

David Spiro

Abstract

Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed for children in the United States. Previous trials evaluating an optional antibiotic prescription are limited and have significant limitations. None have evaluated an optional prescription in the urgent care setting. We conducted a randomized, controlled trial in an urban emergency department in which children aged 6 months to 12 years diagnosed with AOM were randomly assigned a "wait-and-see prescription" (WASP) or a "standard treatment prescription" (STP). Structured phone interviews were conducted 4-6, 11-14, and 30-40 days after enrollment to determine the proportion of each group that filled the antibiotic prescription and outcomes related to the clinical course. Substantially more parents in the WASP group (N=138) did not fill the antibiotic prescription compared to the STP group (N=145) (62% vs. 13%; P<0.001). There were no statistically significant differences between the groups in the frequency of subsequent fever, otalgia or unscheduled visits for medical care. Within the WASP group, both fever (OR = 4.0, 95% confidence interval, 1.7-9.5) and otalgia (OR = 4.5, 95% confidence interval, 1.7-11.5) were associated with filling the prescription. The WASP approach substantially reduced unnecessary use of antibiotics in children and is a reasonable alternative to routine use of antimicrobials for treatment of AOM.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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