38 Guidelines for acute otitis media in children worldwide: useful or useless?
Bibliographic record
Abstract
<h3>Goal</h3> Our aim is to identify, analyze and compare the international guidelines or national consensus reports on the management of acute otitis media (AOM) in children. <h3>Method</h3> We performed a systematic search on PubMed database using the keywords: ‘acute otitis media’ AND [‘children’ OR ‘pediatric’ OR ‘paediatric’] AND [‘guideline’ OR ‘consensus’]. We excluded publications in other languages than English or French and animal studies. A total of 249 papers have been initially found. After exclusion of those that were not relevant (reviews, case series, case reports) we ended up in gathering 27 publications. After full text screening, we excluded papers that did not specifically refer to AOM diagnosis and management. Finally 13 papers matched the criteria. <h3>Results</h3> We found out 11 countries having specific AOM guidelines published in Pubmed: USA, Spain, France, Germany, South Africa, Australia, Korea, Canada, Italy, UK and Japan. Prompt antibiotic treatment is recommended for: 1. all children with temperature over 39 gr C or with otorrhea (Germany, Italy), 2. all children withintracranial complications and/or a history of recurrence (Italy, South African), 3. all children under the age of 2 years (Italy, South Africa, France), 4. children over 2 years old with severe bilateral AOM (Italy), or with failure to respond to symptomatic treatment after 48 to 72 hours (Australia), 5. all children with signs of severe infection (temperature > 38, othorea, otolagia> 48hours) (South Africa, France), 6. children with risk factors: malnourished, immunodepression, ear malformation) (France and South Africa), day-care attendees or siblings of children attending day care centers (South Africa). Amoxicillin is universally accepted as the first-line antibiotic therapy in all included guidelines. The alternative for children allergic to penicillins is the use of macrolides. Some of the guidelines mention the importance of preventive strategies (Italy, Germany, Australia, USA, Spain, Japan, Korea, South Africa). Besides reducing the risk factors, almost all the guidelines encourage pneumococcal and influenza vaccination. The exception is the Spanish guideline which refers to previous studies that showed no direct beneficial effect after vaccination. <h3>Conclusion</h3> These guidelines revealed similarities in many aspects, with variations in specific recommendations, due to local epidemiology and follow-up possibilities. In order to reduce the healthcare burden, there is a special need for developing a global guideline with specific recommendations according to epidemiological differences.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".