Deprecated: Return type of DrupalCacheArray::offsetExists($offset) should either be compatible with ArrayAccess::offsetExists(mixed $offset): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/rprlib/prod72/www/includes/bootstrap.inc on line 362
Deprecated: Return type of DrupalCacheArray::offsetGet($offset) should either be compatible with ArrayAccess::offsetGet(mixed $offset): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/rprlib/prod72/www/includes/bootstrap.inc on line 369
Deprecated: Return type of DrupalCacheArray::offsetSet($offset, $value) should either be compatible with ArrayAccess::offsetSet(mixed $offset, mixed $value): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/rprlib/prod72/www/includes/bootstrap.inc on line 381
Deprecated: Return type of DrupalCacheArray::offsetUnset($offset) should either be compatible with ArrayAccess::offsetUnset(mixed $offset): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/rprlib/prod72/www/includes/bootstrap.inc on line 388 University of Oklahoma Health Sciences Center
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 695 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 696 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 697 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 700 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 702 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in include_once() (line 328 of /home/rprlib/prod72/www/sites/default/settings.php).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in include_once() (line 329 of /home/rprlib/prod72/www/sites/default/settings.php).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in include_once() (line 337 of /home/rprlib/prod72/www/sites/default/settings.php).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in include_once() (line 344 of /home/rprlib/prod72/www/sites/default/settings.php).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_settings_initialize() (line 819 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_settings_initialize() (line 828 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: session_name(): Session name cannot be changed after headers have already been sent in drupal_settings_initialize() (line 831 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Deprecated function: Return type of DatabaseStatementBase::execute($args = [], $options = []) should either be compatible with PDOStatement::execute(?array $params = null): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2244 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::current() should either be compatible with Iterator::current(): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::next() should either be compatible with Iterator::next(): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::key() should either be compatible with Iterator::key(): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::valid() should either be compatible with Iterator::valid(): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::rewind() should either be compatible with Iterator::rewind(): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).
Objectives: The objective of the study was to compare the antibiotic treatment failure and recurrence rates between antibiotic agents (amoxicillin, amoxicillin-clavulanate, cefdinir, and azithromycin) for children with uncomplicated acute otitis media (AOM).
Study design: We completed a retrospective cohort study of children 6 months-12 years of age with uncomplicated AOM identified in a nationwide claims database. The primary exposure was the antibiotic agent, and the primary outcomes were treatment failure and recurrence. Logistic regression was used to estimate ORs, and analyses were stratified by primary exposure, patient age, and antibiotic duration.
Results: Among the 1 051 007 children included in the analysis, 56.6% were prescribed amoxicillin, 13.5% were prescribed amoxicillin-clavulanate, 20.6% were prescribed cefdinir, and 9.3% were prescribed azithromycin. Most prescriptions (93%) were for 10 days, and 98% were filled within 1 day of the medical encounter. Treatment failure and recurrence occurred in 2.2% (95% CI: 2.1, 2.2) and 3.3% (3.2, 3.3) of children, respectively. Combined failure and recurrence rates were low for all agents including amoxicillin (1.7%; 1.7, 1.8), amoxicillin-clavulanate (11.3%; 11.1, 11.5), cefdinir (10.0%; 9.8, 10.1), and azithromycin (9.8%; 9.6, 10.0).
Conclusions: Despite microbiologic changes in AOM etiology, treatment failure and recurrence were uncommon for all antibiotic agents and were lower for amoxicillin than for other agents. These findings support the continued use of amoxicillin as a first-line agent for AOM when antibiotics are prescribed.
Objective: To evaluate the cost-effectiveness of tympanostomy tube placement vs. nonsurgical medical management, with the option of tympanostomy tube placement in the event of treatment failure, in children with recurrent acute otitis media (AOM).
Study design: A Markov decision model compared management strategies in children ages 6 to 35 months, using patient-level data from a recently completed, multicenter, randomized clinical trial of tympanostomy tube placement vs. medical management. The model ran over a two-year time horizon using a societal perspective. Probabilities, including risk of AOM symptoms, were derived from prospectively collected patient diaries. Costs and quality-of-life measures were derived from the literature. We performed one-way and probabilistic sensitivity analyses, and secondary analyses in predetermined low- and high-risk subgroups. The primary outcome was incremental cost per quality-adjusted life-year gained.
Results: Tympanostomy tubes cost $989 more per child than medical management. Children managed with tympanostomy tubes gained 0.69 more quality-adjusted life-days than children managed medically, corresponding to $520,855 per quality-adjusted life-year gained. Results were sensitive to the costs of oral antibiotics, missed work, special childcare, the societal cost of antibiotic resistance, and the quality of life associated with AOM. In probabilistic sensitivity analyses, medical management was favored in 66% of model iterations at a willingness-to-pay threshold of $100,000/quality-adjusted life-year. Medical management was preferred in secondary analyses of low- and high-risk subgroups.
Conclusions: For young children with recurrent AOM, the additional cost associated with tympanostomy tube placement outweighs the small improvement in quality of life. Medical management for these children is an economically reasonable strategy.
