>>Thank you for an informative and colourful magazine. It is a great idea.
I just had one remark. You have a column called the family practitioner. This would be useful if the latest research based information was given. I am not a paediatrician, but The American Academy of Pediatrics new guidelines are not to give antibiotics systematically.
Catherine Meunier puts forward antibiotics as the most common form of treatment. I feel that the most common approach should not be put forward, but the best research based treatment. I believe this is important as antibiotics are drugs with possible side effects for the child and their use increases the number of resistant bacteria which poses a social threat. I join the new guidelines.
Thank you again for all your work. I look forward to reading Tokyo Families again.
Yours truly,
Henrietta Carbonel
Dear Mrs. Carbonel,
Thank you very much for your comments. For nearly two decades the optimal treatment of acute otitis media has been hotly debated. You are perfectly correct that inappropriate use of antibiotics is leading to bacterial resistance. Additionally, all medications can have adverse effects. However, if you carefully read the official AAP guidelines (as opposed to the Q&A to which you have referred) you will note that what I have written consistent with these recommendations. Only in select cases should a “watchful waiting” approach be used:
“This option should be limited to otherwise healthy children 6 months to 2 years of age with non-severe illness at presentation and an uncertain diagnosis and to children 2 years of age and older without severe symptoms at presentation or with an uncertain diagnosis. In these situations, observation provides an opportunity for the patient to improve without antibacterial treatment. The association of age younger than 2 years with increased risk of failure of watchful waiting and the concern for serious infection among children younger than 6 months influence the decision for immediate antibacterial therapy. Consequently, the panel recommends an age-stratified approach that incorporates these clinical considerations along with the certainty of diagnosis.”
Hence, the guidelines, as usual, support good clinical judgement. Unfortunately, in writing a very brief column such as the one in Tokyo Families, it is entirely out of scope to deal specifically with the exceptional or select cases.
Kind regards,
Catherine Meunier M.D., M.Sc., C.C.F.P.
