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The treatment of Otitis media has generally been perceived as a complicated form of treatment because the use of antibiotics is subject to other factors prevailing in the treatment of the disease (Del Mar and Hayem, 1997). To improve patient recovery rates, it has therefore been recommended that, watchful waiting is the most appropriate course of action to take before any course of antibiotic treatment is administered to the patients (American Academy Of Pediatrics and American Academy of Family Physicians, 2004). Furthermore:
“The margin of benefit of antibiotics over placebo in achieving a favorable clinical course does not appear to be large. If such an effect justifies a global policy in favor of, or against prescribing antibiotics for children with AOM, is a multifaceted issue” (Voulomanou et.al, 2009, p. 3).
Watchful waiting therefore stands as a recommended action in the treatment of otitis media, but this is just one among many alternatives to be reviewed before the treatment of otitis media or the administration of antibiotics (Stan, 1997). In watchful waiting, the course of treatment is summarized by Morris and Leach (2009) as:
“Symptomatic pain relief if experienced, watchful waiting with advice to parents on likely course and possible complications. For low-risk populations, antibiotics are most likely to benefit those who have AOM with perforation, <2 years and bilateral AOM, already had 48 hours of watchful waiting and no improvement, or are at high risk of suppurative complications (especially perforation of the tympanic membrane). For high risk populations, antibiotics are recommended” (p. 1387).
It is therefore important to weigh the available treatment of options of otitis media before any course of action is taken. In this regard, watchful waiting stands out as the best treatment method for treating children with otitis media.
In the treatment of otitis media, there are usually two courses of treatment: Watchful waiting and the immediate administration of antibiotics. However, before any of these options are pursued, there ought to be a thorough evaluation of the patient’s history and symptoms to determine the appropriateness of the treatment course chosen. To be specific,
“The clinical practice guideline issued by the American Academy of Pediatrics and the American Academy of Family Physicians endorsed watchful waiting as an option for children six to 23 months of age in whom illness is “non-severe”… Among children six to 23 months of age with acute otitis media, treatment with amoxicillin–clavulanate for ten days tended to reduce the time to resolution of symptoms and reduced the overall symptom burden and the rate of persistent signs of acute infection on otoscopic examination” (Hoberman et.al, 2011, p. 105-106).
The application of watchful waiting as a primary treatment method is therefore justified here because the motions of child growth should be effectively considered in the treatment of otitis media. The adoption of the most effective treatment method should therefore be based on the treatment course to produce the best treatment outcome. Furthermore, Hoberman et.al (2009) suggests that the following criterion should be determined:
“The benefit must be weighed against concern not only about the side effects of the medication but also about the contribution of antimicrobial treatment to the emergence of bacterial resistance. These considerations underscore the need to restrict treatment to children whose illness is diagnosed with the use of stringent criteria” (p. 105).
From the information obtained in existing research studies, it should therefore be assumed that the best treatment method should be adopted after factoring all relevant information. In this manner, the research information obtained from the existing research data contained in this study will be of high value in improving nursing practices.
For a long time, researchers carrying out research studies relating to vulnerable populations experience several ethical challenges (Richter, 2007). As a result, there have been increased concerns regarding the protection of member rights of such vulnerable groups to promote their general wellbeing and comprehensively protect them from being exploited. Since the contents of this study concerns children as a special vulnerable group, ethical issues regarding obtaining of legal consent for the pursuit of several medical treatment methods may arise, and sometimes, ethical issues regarding “autonomy, disclosure, competence and understanding, consent and voluntariness, beneficence and non-maleficence, and justice” can be realized (Richter, 2007, p. 117). Informed consent is especially a serious ethical concern because children are normally regarded as minors (by law) and legal consent can only be obtained from legal guardians. Here, the situation becomes difficult when children lack a legal guardian. Issues relating to confidentiality may also be experienced when treating children because they are not likely to divulge information to healthcare practitioners if they do not feel safe or comfortable with them. Guaranteeing such population groups with the promise of confidentiality will therefore go a long way in obtaining the right information to base future treatment methods.
References
American Academy of Pediatrics (2004). Clinical Practice Guidelines. Web.
American Academy Of Pediatrics and American Academy of Family Physicians. (2004). Diagnosis and Management of Acute Otitis Media. Pediatrics, 113(5), 1451 – 1465.
Del Mar, C.B. and Hayem, M. (1997). Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ, 314, 1526.
Hoberman, A., Paradise, J.L., Rockette, H.E., Shaikh, N., Wald, E.R., Kearney, D.H., Colborn, K., Kurs-Lasky, M., Bhatnagar, S., Haralam, M.A., Zoffel, L.M., Jenkins, C., Pope, M.A., Balentine, T.L., and Barbadora, K.A. (2011). Treatment of acute otitis media in children under 2 years of age. The New England Journal of Medicine, 364(2), 105-115.
Kelley, P. E., Friedman, N., Johnson, C. (2007). Current Pediatric Diagnosis and Treatment. New York: Lange Medical Books/McGraw-Hill.
McCracken, G. H. (1998). Treatment of acute otitis media in an era of increasing microbial resistance. Pediatric Infectious Disease Journal, 17, 576–579.
Morris, P.S., and Leach, A.J. (2009). Acute and chronic otitis media. Pediatric Clinics of North America, 56, 1383-1399.
Richter, M. S. (2007). Ethical issues surrounding studies with vulnerable populations: a case study of South African street children. Int J Adolesc Med Health, 19(2), 117-26.
Stan, B. (1997). Causative Pathogens, Antibiotic resistance and therapeutic Considerations in Acute Otitis Media. The Pediatric Infectious Diseases, 16(4), 449-456.
Voulomanou, E.K., Karageorgopoulos, D.E., Kazantzi, M.S., Kapaskelis, A.M., and Falagas, M.E.(2009). Antibiotics versus placebo or watchful waiting for acute otitis media: a meta-analysis of randomized controlled trials. Journal of Antimicrobial Chemotherapy, 64(1), 16-24.
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