Clinical decision analysis in the treatment of acute otitis media in a child over 2 years of age.

Acute otitis media (AOM) is the most common infection diagnosed in children. In Canada and the United States, the standard of care for treatment of children over 2 years of age diagnosed with AOM is a course of antibiotics for 5 to 10 days. However, in other countries, treatment is primarily symptomatic, and antibiotics are prescribed only if symptoms fail to resolve. Clinical decision analysis is a process whereby different treatment options are assessed systematically. All clinical pathways are incorporated into a model, probabilities for each event are determined from the literature, and clinical outcomes are quantified as to the preference of patients. The decision analysis then determines the most appropriate treatment option for the disease process. For AOM in a child over 2 years of age, four treatment options were considered including observation followed by 10 days of antibiotic therapy if required for failure of symptoms to resolve, observation followed by 5 days of antibiotic therapy if required, 10 days of antibiotic therapy when the child was initially diagnosed with AOM, and 5 days of antibiotic therapy when the child was initially diagnosed with AOM. Using a clinical decision analysis model for the treatment of AOM in a child over 2 years of age, the most appropriate treatment was found to be initial observation followed by 5 days of an antibiotic if the child failed to improve spontaneously. The decision analysis model developed was designed to be free of construction bias and was found to be robust in multiple sensitivity analysis.