AHRQ Data on Antibiotic Use in Children with Otitis Media

As part of its Medical Expenditure Panel Survey, the Agency for Healthcare Research and Quality (AHRQ) examined the use of antibiotics to treat otitis media in children. These data appear in “Research Findings 23: Trends in Children’s Antibiotic Use: 1996 to 2001,” which is available online at: http://www.meps.ahrq.gov/printproducts/print-prod_detail.asp?id=683.

According to the survey, the proportion of children who were given antibiotics to treat ear infection caused by otitis media declined from 14.4 percent in 1996 to 11.5 percent in 2001, and the average number of antibiotic prescriptions per child for any reason declined from 0.9 to 0.5 in the same time frame. One third of all antibiotics purchased for children are for the treatment of otitis media. These data suggest that campaigns initiated in the mid-1990s by the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and others to reduce the inappropriate use of antibiotics have been effective.

The study also showed that the percentage of children who used antibiotics for any reason from 1996 to 2001 declined from 39 to 29 percent. Regardless of a child’s age, race or ethnicity, gender, household income, insurance status, health status, and geographic location, a decline is apparent in the percentage of children using antibiotics and the average number of antibiotic prescriptions per child.

AHRQ Review of Routine Episiotomy in Uncomplicated Births

The Agency for Healthcare Research and Quality (AHRQ) has reviewed the use of routine episiotomy in uncomplicated vaginal births. “The Use of Episiotomy in Obstetrical Care: A Systematic Review” (AHRQ Evidence Report/Technical Review no. 112) appears in the May 1, 2005, issue of the Journal of the American Medical Association, and is available online at: http://www.ahrq.gov/downloads/pub/evidence/pdf/episiotomy/episob.pdf.

Researchers found that episiotomy performed during uncomplicated vaginal birth does not provide immediate or long-term benefit for the mother. Episiotomy is used in approximately one third of vaginal deliveries to hasten birth and prevent tearing of the perineum during delivery.

Women who had spontaneous tears of the perineum without episiotomy had less pain and no more complications related to healing than women with episiotomies. It also was noted that episiotomy did not protect women against urinary or fecal incontinence, pelvic organ prolapse, or difficulties in sexual function in the first three months to five years after delivery.

According to the AHRQ, a two-stage repair, which sutures the underlying layers of tissue but leaves the perineal skin unsutured, is more beneficial than a three-stage repair, which sutures the perineal skin. The researchers also found that continuous, subcuticular suturing may be superior to interrupted, transcutaneous suturing, and that polyglycolic acid sutures may be superior to chromium cat gut for episiotomy suturing.

Because the review did not include neonatal outcomes, possible benefits of episiotomy for babies were not addressed.