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Choosing Wisely Australia

Royal Australian & New Zealand College of Ophthalmologists

It is indicated when there is clear evidence of progression via change in refraction, anterior and posterior topographical data and tomographic data. In younger patients’ consideration can be given to cross-linking without evidence of progression if there is a strong index of suspicion that progression will occur without intervention.

Choosing Wisely Canada

Canadian Society of Otolaryngology–Head & Neck Surgery

While endoscopic sinus surgery (ESS) has been found to be an effective therapy in children with chronic rhinosinusitis, comparable outcomes can be achieved with medical therapy and adenoidectomy. A stepwise approach of medical therapy, progressing to adenoidectomy, then to ESS allows children to be treated with a less invasive and more cost-effective interventions as initial therapy, while saving ESS for those who are refractory to primary interventions. Maximal medical therapy should be ...

Choosing Wisely Canada

Canadian Society of Otolaryngology–Head & Neck Surgery

For children who have a lower number of recurrent throat infections, tonsillectomy has significantly less benefits when compared to those with more frequent infections, and many children with recurrent throat infections naturally improve without intervention. Therefore, where safely possible, avoidance of tonsillectomy for children with lower numbers of acute infections is recommended. This avoids unnecessary tonsillectomy and the costs and complications associated with the procedure (i.e., ...

Choosing Wisely Canada

Canadian Society of Otolaryngology–Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere

Administration of perioperative antibiotics for children undergoing tonsillectomy shows no significant benefits in regard to common post-tonsillectomy morbidities. Overuse of systemic antibiotics increases bacterial resistance and the risk of adverse drug events unnecessarily. These concerns outweigh the reduction in postoperative fever which is the only potential benefit of perioperative antibiotic administration for elective tonsillectomy. Therefore, perioperative antibiotics are not ...

Choosing Wisely Canada

Canadian Society of Otolaryngology–Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere

Codeine has been associated with a high rate of adverse drug reactions in children. This includes life-threatening respiratory depression. Appropriate dosing of codeine is challenging due to the genetic heterogeneity amongst patients for the CYP2D6 enzyme, which is responsible for codeine metabolism. Genetic screening of CYP2D6 is not routinely performed and can not reliably identify variations in codeine metabolism rates amongst patients. As such, children who are ultra-fast metabolizers of ...