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It is not recommended to prescribe oral antibiotics for children with uncomplicated tympanostomy tube otorrhea or uncomplicated acute otitis externa.
Choosing Wisely Canada
Canadian Society of Otolaryngology–Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere
The use of oral antibiotics where they are not necessary can promote antibiotic resistance and increase the risk of opportunistic infections. Topical antibiotics achieve higher concentrations in the ear canal, demonstrate improved patient satisfaction, are associated with fewer adverse events, and are shown to have equal efficacy for treatment of acute tympanostomy tube otorrhea (TTO) and acute otitis externa (AOE) when compared to oral antibiotics. For these reasons, topical antibiotics rather ...
ver más ... 2020It is not recommended to transfer a patient by ambulance with skilled personnel if the patient is unlikely to require medical intervention en route.
Choosing Wisely Canada
Public Health Physicians of Canada
Health personnel are valuable resources in rural communities. Sending a nurse or physician en route to an urban centre can leave a rural hospital without medical support for significant periods of time. Consider the evidence when deciding whether a patient needs to be accompanied during transport. Consider calling the receiving hospital to mutually agree on the need for skilled personnel during urgent or emergent transport.
ver más ... 2020It is not recommended to prescribe intranasal/systemic steroids, antihistamines or decongestants for children with uncomplicated otitis media with effusion.
Choosing Wisely Canada
Canadian Society of Otolaryngology–Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere
In most cases, medical treatment using antihistamines, decongestants, systemic antibiotics and steroids have shown little to no effect on the long-term outcomes of uncomplicated otitis media with effusion (OME) in children. Because of this, and the costs and potential side effects, it is not recommended to prescribe these medical treatments for children with uncomplicated OME. The exception to this would be for children with coexisting conditions in which these medications are indicated for ...
ver más ... 2020Is it not recommended to call in staff for an investigation (i.e. blood test, imaging, operative procedures, etc.) at off-service hours unless it is likely to change management.
Choosing Wisely Canada
Public Health Physicians of Canada
Health personnel are valuable resources in rural communities. It is important that provider well-being is balanced with optimal patient care, especially where human resources are limited.
ver más ... 2020It is not recommended to place tympanostomy tubes in most children for a single episode of uncomplicated otitis media with effusion of less than 3 months’ duration.
Choosing Wisely Canada
Canadian Society of Otolaryngology–Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere
Although tympanostomy tube insertion can be associated with short-term quality of life improvements, the natural history of otitis media with effusion (OME) is sufficiently favorable and most OME in children will spontaneously resolve within 3 months. Cases of OME which last longer than 3 months are typically chronic in nature, and less likely to resolve without intervention. Limited data exists regarding the efficacy of tympanostomy tube insertion in children with OME for less than 3 months. ...
ver más ... 2020