Table 1Mode of delivery of antibiotic management strategies

StudySpiro et al. (2006)Little et al. (2001)McCormick el al. (2005)
Antibiotic prescribing strategyDelayedDelayedDelayed
Duration of delay2 days3 days2 days
Methods of delayPrescription was given to parents during the consultation with the healthcare professional.Parents were asked to come back to collect the prescription (prescription left at the reception).Prescription was given to parents during the consultation with the healthcare professional.
Verbal adviceNoParents were also advised to use the prescription if their child had a discharge for 10 days or more.
GPs were supported by standardised advice sheets.
Advice on antibiotics given: that antibiotics do not work very well and have disadvantages such as adverse events and development of antibiotic resistance.
Parents of children received an educational intervention on definition of ear infection, causes of ear infection, characteristics of non-severe and severe AOM, antibiotic resistance, costs of antibiotics, rate of symptom response to antibiotics, possible adverse outcomes associated with immediate antibiotics versus delayed including the risk of mastoiditis.
Use of information leafletNoNoNo
Use of analgesicsAll patients received ibuprofen (100 mg/5 ml) and otic analgesic drops (4 drops every 2 hours if needed).Advice on full doses of paracetamol for relief of pain and fever.
Ibuprofen as well if child already taking full doses of paracetamol and is aged over 1 year.
Symptom medication provided (ibuprofen).
ImmediateImmediateImmediate
Duration of delayN/AN/AN/A
Methods of delayN/AN/AN/A
Verbal adviceNoGPs were supported by standardised advice sheets.
Advice on benefit of antibiotics in helping symptoms to settle and prevent complications; importance of taking the full course.
Parents of children received an educational intervention on definition of ear infection, causes of ear infection, characteristics of non-severe and severe AOM, antibiotic resistance, costs of antibiotics, rate of symptom response to antibiotics, possible adverse events associated with immediate antibiotic versus delayed antibiotic prescribing, including the risk of mastoiditis.
Use of information leafletNoNoNo
Use of analgesicsAll patients received ibuprofen (100 mg/5 ml) and otic analgesic drops (4 drops every 2 hours if needed; each ml contains 54 mg antipyrene, and 14 mg benzocaine).Advice on full doses of paracetamol for relief of pain and fever.
Ibuprofen as well if child already taking full doses of paracetamol is aged over 1 year.
Symptom medication provided (ibuprofen).

From: 2, Evidence review and recommendations

Cover of Respiratory Tract Infections - Antibiotic Prescribing
Respiratory Tract Infections - Antibiotic Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary Care.
NICE Clinical Guidelines, No. 69.
Centre for Clinical Practice at NICE (UK).
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