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Research Questions

Write about the Use of Antibiotics in Preventing Recurrent Acute for Effusion.

There is an extensive but controversial medical literature on medical resources needed to address problems related to otitis media. Recently, use of certain antibiotics in children suffering from otitis media has raised concerns from different quarters. Acute otitis media (AOM) can be addressed by use of antibiotics or surgical treatment; in which either treatment has certain benefits and demerits, warranting extensive debates and consultations before settling for one. For those who propose recurrent antibiotic treatment of recurrent AOM, the choice, timing and the period of antibiotic prophylaxis are to be resolved. There is uncertainty for otitis media effusion (OME) as to whether antibiotic offer placebo advantage (Rovers, Schilder, and Zielhuis, 2004 p. 22). The research is aimed at addressing these concerns hence the need for meta-analyses of antibiotic’s role in porphyries of recurrent AOM and OME treatment.

Research questions that need to be satisfied include; 1. What is the magnitude of the effect of treatment of prophylactic a suppression of antibiotic of recurrent AOM? 2.  what effect exists, if the details of using an antibiotic choice of timing, duration, and timing offer the highest beneficial effect. 3. What is a short-term magnitude of treatment effect if any, of OME resolution with antibiotic, 4. If OME effect exists in the short term.  If there are long-term benefits. 5.  If there is a presence of treatment effect with OME, what are the antibiotics optimal use, 6? Does the treatment vary for either condition by the characteristic of the patient that is known as the rates influencers of AOM such as group setting, age, socioeconomic status, and season of the year (Jacobs, Springer, and Crothers, 2001 p. 166)?

The main goals during treatment of recurrent otitis media include preventing of faster progression of infectious, addressing AOM complication, preventing hearing prevention deficits and promoting language development. The antibiotic studies use of either treatment of OME or prophylaxis of recruitment AOM were identified by MEDLINE during a 1996 search using refined searching that was linked with the otitis media phase. With one of the following terms; prospective, clinical trials, random models, placebo, statistical, placebos, the articles that were identified to help study more about the problems (Harrison, Tyler, Smith, and Findlay, 2004. P.45); the results confirmed that goals of treatment are as discussed herein.

Monographs, textbooks and current contents were searched. Use of randomly published controlled trials of the use of antibiotics in the AOM recurrent or OME was selected. The estimated effects of the submission and publication of studies with the findings that are null by the standard approach. The inclusion articles meeting criteria were obliged to conceal the source of authors, study location, publication and medication use. The results and methods sections were viewed independently, reviewed by reviewers who rated every article for ideal adherence characterized by a randomized controlled trial using a rating form that was standard (Hunink, Weinstein, Wittenberg etl 2014. P. 674).  The reviewers also used an additional scoring sheet to rate the potential of the assessed report of confounding factors such age, race, status, duration, socioeconomic factors, disease, the previous therapy used for otitis media and the first episode of otitis media. Differences between reviewers’ accurate rating on specific items got solutions by the third blinded reviewer. The evaluation summary scores were rated. Articles that were selected were used for four meta-analyses separately. For sufficient outcome reports were used for more than analysis and the authors provided presented more data for more than one outcome. 

Goals for Patients with Recurrent Otitis Media

Meta-analyses addressed the use of antibiotics in the prophylaxis of recurrent AOM. Examining the episode frequency of meta-analyses. These go into the data present the number of patients per month. The outcome of treatment of OME was reported in this period; the outcome used the closest to a month after treatment. The patients in this group were in the unit of analysis. Free effusion for the patient to consider benefited treatment. The report that was similar with an exception the unit of outcome in the articles was cleared. A more conservative measure of the outcome the patient. The patient is one of the meta-analysis.

Statistical analysis method DerSimonian analyses were used as well as Laird to calculate the differences in rates of treatment approximation and the effect at 95% confidence interval (Kemper, and Cohen, 2004.p 55). The random effect the random effect did not ensure homogeneity of the study population and incorporated different variability into the estimates. The effect summary statistics of effect using the approach is measured by terms of error within every study as the results are shown.

The findings of the meta-analysis offer support that is mixed for the use of antibiotics in the prophylaxis or treatment of OME and the recurrent AOM. Prophylaxis treatment works best for children with AOM intermittent with regards to prevention of AOM. The effect was limited by treatment requirement in which it showed ten children desirable treatment outcomes (Tan, Brainard, and Larkin, 2015 p. 455). However, the small RD is necessary to stand out given the nature of antitoxic and attraction risk (surgical treatment)

There is lack of sufficient indication to recommend a particular antibiotic, although using sulfisoxazole seems to have better treatment outcomes compared with other antibiotics. The insufficient evidence fails to provide a recommendation on the treatment duration or the effect of the recurrence rates of AOM before therapy. For the case of OME, the antibiotics appear to be useful in a short course or short-term effusion clearance. With regard as to whether one considers it being the outcome of treatment. The effect is limited; however other patients need to be treated to improve the result in one of them and relatively short duration. In in a month or more after completion of treatment, there is no statistical improvement in comparison with control.

Prevention of delays in language development is the major goal of OME treatment as well as general realization of developmental milestones that may be delayed by hearing deficits. Lack of effectiveness in treatment, in the long term, leads to questioning the value of antibiotic treatment with regards to its administration to achieve its goals. Language is not acquired in the short term interval. If there is persistence in the antibiotic treatment for a short duration, the goal may not be achieved. Additionally, recent studies conducted with placebo control tend to indicate lesser short-term antibiotic benefits. With meta-analysis, the findings reported herein rely on the concluded studies in the analysis. Two of the analyses suggest that those of the current otitis media and of OME with the outcome of measure involving the use of data that are not entirely independent. The results of the research could come more than once in one child since raw data was not available. However, since raw data was not available to address the question, and since methodology was not approached statistically through meta-analysis, type two errors were not excluded properly.

Methods

Very few studies consider a few of the many potential factors that were confounded in the survey design. These analyses were also unable to address the question about how the characteristics of the patient influenced the effect of treatment.  The lack of methodological rigor in the study included as indicated by the low-quality scores were considered as findings limitation. The study quality, however, shows that over and above assignment of patients randomly to treatment to be as considered finding’s limitation. The correction of the survey on the quality over and above the treatment of patients to be compared.

The pooled showed findings an RD favoring the treatment of the antibiotic of 0.11 OAM episodes patient –month (CI, 0.03 to 0.19 95%) the control in the group was 0.19. The pooled findings showed an RD favoring treatment of 0.11 events. The control rate groups were 0.19 (CI, 0.13 TO 0.26 95%). Three studies with 121 subjects in a total used crossover design. Excluding the crossover of the studies produced no change. Studies that used sulfisoxazole had a trend a better outcome (RD, 0.20;95%) (Young, Peppard, and Gottlieb, 2002.p 1218)

OME Treatment, long tern common effects. The meta-analysis 4. In the meta-analysis, eight students were included 0f short-term to long-term outcome of the treatment of OME with antibiotics. Five studies had the results of favoring the treatment of antibiotic and three studies supported placebo, and two showed a small difference or no difference at all. One had CIs that zero was inclusive. In a pooled analysis it was found that little evidence for long-term or average benefit from antibiotic from antibiotic treatment of OME. When there was a division of studies by the use of ear or the patient as the outcome the results remained the same. With the patient the RD was o. o1 (95% CI, 0.06-0.08); with the ear was 0.12 (95% CI, 0.14 TO 0.26). Elimination on the study using the antibiotic of efficiency that is questionable (penicillin) did not affect the findings. Likewise, the division of the studies by the treatment duration.

Gens tends to produce treatment effects than the other antibiotics better; the statistical differences are not significant. Regarding the term of the therapy, no trend is the apparent or preexisting disease. These are with reason that the primary goal of OME treatment is preventing language or developmental delays due to the deficit of earing. The lack of long-term effectiveness results to one questioning the value of antibiotic treatment as it is currently administered in achieving this goal (Schneeweiss, 2007, p.144). In the short interval of time language is not acquired. If there is the persistence of antibiotic treatment for a short period only the goal my not achieved. Additionally, more recent studies and the studies conducted with controls placebo tended to show secondary benefits in short-term of the antibiotics.

Statistical Analysis

With any meta-analysis, the reported findings herein show on the studies in the analysis that was concluded. Three of the meta-analyses of those otitis media and OME that was recurrent with the ear as the measure of the outcome. The involvement of the use of the data that are not independent fully. The outcome under study occurred more than once in the same child. Since the used data was raw from the studies were unavailable, the statistical correction could not be appropriate and cloud not be the correction for this unknown dependency level (Thomas, and Witte, 2002, p. 510). The approach used is conservative in the correction for dependence would have resulted to narrow CIs. 

As the studies disagree on the duration of treatment, it’s possible that combining the results from all the studies may affect the difference between the results response curves at distinct points in time. However, since there was no raw data in the study to address the question and methodology did not exist to give the correction; as such straight-line was selected in response curves. Finally, there is currently no approach that is standard to calculating power for statistics summary obtainable through meta-analysis leading to exclusion of type II possibility in some of the null comparisons (Roberts, Rosenfeld, and Zeisel, 2004, p.240). The study design factors were very few that produces low scores. The limitation of the findings correction of the quality study over and above assignment is randomly given to patients to the treatment that is compared has not altered the results.  When it has been done in the different meta-analysis and found no correlation between observed RD and quality (Welcome Trust Case Control Consortium, 2007 p. 663).  

Conclusion

Antibiotics appear to have limited effect in treatment of OME but beneficial in treatment of recurrent otitis media and resolution of OME in the short run. OME long-term benefits have not been identified clearly. Most studies seem to be failing to consider their potential to produce usable recommendations. This has contributed to the inability to determine groups of patients’ that are most likely to benefit. There is uncertainty whether antibiotic treatment for otitis media with OME effusion offer any benefit over placebo. The meta-analysis in prophylaxis antibiotics of recurrent AOM and OME treatment attests to that. 

References

Rovers, M.M., Schilder, A.G.,and  Zielhuis, G.A. 2004. Otitis media. The Lancet, 363(9407), pp.465-473.

Klein, J.O., 2000. The burden of otitis media. Vaccine, 19, pp.S2-S8.

Jacobs, J., Springer, D.A. and Crothers, D., 2001. Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. The Pediatric infectious disease journal, 20(2), pp.177-183.

Block, S.L., Hedrick, J., Harrison, C.J., Tyler, R., Smith, A., Findlay, R. and Keegan, E., 2004. Community-wide vaccination with the heptavalent pneumococcal conjugate significantly alters the microbiology of acute otitis media. The Pediatric infectious disease journal, 23(9), pp.829-833.

Lieberthal, A.S., Carroll, A.E., Chonmaitree, T., Ganiats, T.G., Hoberman, A., Jackson, M.A., Joffe, M.D., Miller, D.T., Rosenfeld, R.M., Sevilla, X.D. and Schwartz, R.H., 2013. The diagnosis and management of acute otitis media. Pediatrics, 131(3), pp.e964-e999.

Hunink, M.M., Weinstein, M.C., Wittenberg, E., Drummond, M.F., Pliskin, J.S., Wong, J.B. and Glasziou, P.P., 2014. Decision making in health and medicine: integrating evidence and values. Cambridge University Press.

Degenhardt, B.F. and Kuchera, M.L., 2006. Osteopathic evaluation and manipulative treatment in reducing the morbidity of otitis media: a pilot study. The Journal of the American Osteopathic Association, 106(6), pp.327-334.

Tan, E., Brainard, A. and Larkin, G.L., 2015. Acceptability of the flipped classroom approach for in?house teaching in emergency medicine. Emergency Medicine Australasia, 27(5), pp.453-459.

Kemper, K.J. and Cohen, M., 2004. Ethics meet complementary and alternative medicine: new light on old principles.

Laxminarayan, R., Duse, A., Wattal, C., Zaidi, A.K., Wertheim, H.F., Sumpradit, N., Vlieghe, E., Hara, G.L., Gould, I.M., Goossens, H. and Greko, C., 2013. Antibiotic resistance—the need for global solutions. The Lancet infectious diseases, 13(12), pp.1057-1098.

Marchisio, P., Nazzari, E., Torretta, S., Esposito, S. and Principi, N., 2014. Medical prevention of recurrent acute otitis media: an updated overview. Expert review of anti-infective therapy, 12(5), pp.611-620.

Roberts, J.E., Rosenfeld, R.M. and Zeisel, S.A., 2004. Otitis media and speech and language: a meta-analysis of prospective studies. Pediatrics, 113(3), pp.e238-e248.

Thomas, D.C. and Witte, J.S., 2002. Point: population stratification: a problem for case-control studies of candidate-gene associations? Cancer Epidemiology and Prevention Biomarkers, 11(6), pp.505-512.

Wellcome Trust Case Control Consortium, 2007. Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls. Nature, 447(7145), p.661.

Schneeweiss, S., 2007. Developments in post?marketing comparative effectiveness research. Clinical Pharmacology & Therapeutics, 82(2), pp.143-156.

Young, T., Peppard, P.E. and Gottlieb, D.J., 2002. Epidemiology of obstructive sleep apnea: a population health perspective. American journal of respiratory and critical care medicine, 165(9), pp.1217-1239.

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