Nice Guidelines Re Otitis Media

[237SJ]

Yesterday a nurse at a walk in centre told me that they don`t treat otitis media with antibiotics anymore because it`s viral. I`ve had otitis media that wasn`t viral (caused by swimming pool water going through a grommet into the middle ear). If otitis media was just left alone, would it just get better on it`s own?

[scorpiojo]

http://www.theanswerbank.co.uk/ChatterBank/Question1334113.html

[Sqad]

Well...well.....the old old story.......should one give antibiotics for infections?

How do you know it's viral or bacterial?

You don't.

You could wait for 48 hours and just give pain relief and if there was no improvement, then give antibiotics. We have had such a thread recently where i suggested this and was severely criticized...even libeled from "lay ABers.
So I had better watch my reply.

I would certainly be happy to treat a case of otitis media with NO antibiotics for 48 hours to assess the result. if no improvement, then i would give antibiotics.
If a doctor wanted to give antibiotics from the start......I would have no argument with that approach.

There is NO indication for giving antibiotics to secretory otitis media (glue ear).

[237SJ]

But what about if a load of chlorinated water goes through a grommet and you are weeping disgusting pink gunky liquid from your lugholes and can`t hear for toffee? :-) That`s not viral is it?

[237SJ]

I`ll come back later. My mate`s going to kill me as I`m supposed to be in Richmond at 2 and I haven`t even left yet. Thanks for the reply.

[Sqad]

It might be.........but probably not.

This is a clinical decision to be made by a doctor and not a nurse............

Rather than antibiotics, it sounds as though your ear needs clearing out with suction, which could only be done at an ENT clinic.

[Sqad]

http://cks.nice.org.uk/otitis-media-acute#!scenariorecommendation

That is what NICE says about antibiotics in otitis media.

The nurse was wrong.

I am irritated that I have had to go to a website to be advised by a body to tell me what and when to prescribe.

[anneasquith]

sqad, why are you irritated if you are no longer '' prescribing '' ?

[Sqad]

anneasquith.......Medicine was and still is my whole life.........I have always regarded patients on an individual basis, each person separately.

I have now the distinct feeling that medicine is being taken out of the clinical expertise of a medically qualified person into the domain of the internet devoured by "amateur doctors."

I have also come to the conclusion that the subject and hobby that i have loved all my life is being directed into a "tick box" entity which in my opinion does little benefit to the patient.

Does that answer your question?

[anneasquith]

not really :) :) its called progress , whether we agree with it or not.

[Sqad]

237SJ...in your specific case, it is likely to be an otitis externa predominantly and no, I would n't give antibiotics by mouth, but would give them in the form of ear drops..e.g Gentisone H.
However, it is unreasonable for a nurse to make that diagnosis or prescribing decision unless she is ENT trained.

[237SJ]

Thanks for the replies. It wasn`t me Sqad. I took my Mum to a walk in centre yesterday because her hearing became really muffled over the last few days and I wanted someone to check whether she had an ear infection. She didn`t but I mentioned otitis media to the nurse who dealt with us and she told me about the guidelines. When I had the otitis media with the pink gunk (nor the first time I have had it) I knew the infection was in the middle ear because I couldn`t clear my ears at all. I have never had otitis media on it`s own. It`s always been a secondary infection from something going on in the throat so I think it has always been bacterial as far as I know. There is no way I am going to go sick from work and sit at home with otitis media for 2 weeks without antibiotics just in case it just happens to be viral. As you say, each case should be investigated in it`s own right.

[Sqad]

237SJ....ah! right.

It is a concern of mine that nurses are left in charge of diagnosis and treatment.....an accident waiting to happen and then it will be a matter of who was responsible, the nurse or the non present doctor.

[Peter Pedant]

Not having an awful lot of experience in ENT, where otitis media is as common as muck,
and not liking NICE guideines an awful lot but recognising they control parts of our lives...

I can see that 237 SJ isnt run-of-the-mill. History of perforation, history of grommets, history of multiple infection and isnt aged 7 either.


In answer to 237 SJ's question - the question of use of antibiotics in children with otitis media was answered by a researching GP - Fry I think, in the seventies. And he published his results - in his book I think.
Two series - children with and without antibiotics and the courses were identical. ergo antibiotics not needed, and the early infection is probably viral.

Clearly NOT what 237 SJ is talking about
and whole thread shows the dangers and advantages of slavish adherence to guidelines.

[Peter Pedant]

Sqad - we know the answer to that

the principle put paid to group-prescription - a fad from a few years ago.

No doctor - nurse is professionally liable from the NMC [ nb exciting new reforms envisaged for health regulation bringing it under one umbrella ]

doctor pokes his head in - then he is [GMC rules ]

Employer liable for tort under vicarious liability

This is the position in England and Wales - Timbuctoo where you are Sqad no idea.

[Sqad]

PP......good points.
Unfortunately doctors treat patients and not necessarily disease processes, they demand antibiotics.......just read some of the answers in Health.

[pixie373]

They are trying to minimise prescribing antibiotics. The principle seems to be- don't treat it for 4/5 days and if no improvement, then prescribe antibiotics.