Search PubMed⌕ Search

Biomedical subjects

David M Spiro

Publications and source records attributed to David M Spiro.

8 recordsLinked to original sources
PubMed2006

Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial.

CONTEXT: Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed for children. Previous trials that have evaluated a "wait-and-see prescription" (WASP) for antibiotics, with which parents are asked not to fill the prescription unless the child either is not better or is worse in 48 hours, have excluded children with severe AOM. None of these trials were conducted in an emergency department. OBJECTIVES: To determine whether treatment of AOM using a WASP significantly reduces use of antibiotics compared with a "standard prescription" (SP) and to evaluate the effects of this intervention on clinical symptoms and adverse outcomes related to antibiotic use. DESIGN, SETTING, AND PATIENTS: A randomized controlled trial conducted between July 12, 2004, and July 11, 2005. Children with AOM aged 6 months to 12 years seen in an emergency department were randomly assigned to receive either a WASP or an SP. All patients received ibuprofen and otic analgesic drops for use at home. A research assistant, blinded to group assignment, conducted structured phone interviews 4 to 6, 11 to 14, and 30 to 40 days after enrollment to determine outcomes. MAIN OUTCOME MEASURES: Filling of the antibiotic prescription and clinical course. RESULTS: Overall, 283 patients were randomized either to the WASP group (n = 138) or the SP group (n = 145). Substantially more parents in the WASP group did not fill the antibiotic prescription (62% vs 13%; P<.001). There was no statistically significant difference between the groups in the frequency of subsequent fever, otalgia, or unscheduled visits for medical care. Within the WASP group, both fever (relative risk [RR], 2.95; 95% confidence interval [CI], 1.75 - 4.99; P<.001) and otalgia (RR, 1.62; 95% CI, 1.26 - 2.03; P<.001) were associated with filling the prescription. CONCLUSION: The WASP approach substantially reduced unnecessary use of antibiotics in children with AOM seen in an emergency department and may be an alternative to routine use of antimicrobials for treatment of such children. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00250900.

Acute Disease↗
PubMed2006

Thinking big.

Explore the source record for details and available documents.

Adolescent↗
PubMed2005

Estimation of airway obstruction using oximeter plethysmograph waveform data.

BACKGROUND: Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. METHODS: Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. RESULTS: There were significant relationships between maximal change in area under the curve (P < .0001) or height (P < 0.0001) and mouth pressure. CONCLUSION: The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases.

Adult↗
PubMed2005

Antibiotic-induced mesenteric adenopathy in an intussusception mouse model: a randomized, controlled trial.

BACKGROUND: Idiopathic intussusception is a leading cause of intestinal obstruction in young children. Although the etiology remains obscure, lymphoid hyperplasia is found in a majority of cases. Antibiotics, the most frequently prescribed medication class in the pediatric population, have been recently associated with intussusception. The authors sought to determine whether enteral antibiotic exposure influences the development of mesenteric adenopathy, bowel dilation or intussusception in an animal model. MATERIALS AND METHODS: The authors conducted a randomized, controlled animal trial using a previously described intussusception model. Mice were gavaged with normal saline, amoxicillin-clavulanate or azithromycin twice daily for 5 days to assess the influence of enteral antibiotic exposure on intussusception, mesenteric adenopathy and bowel dilation. One pediatric surgeon performed all laparotomies and was blinded to group designation. Chi2 and Fisher exact tests were used to evaluate differences between antibiotic exposed and control groups. RESULTS: Mesenteric adenopathy was identified in 4.1% of the normal saline controls compared with 54.1% (P < 0.01) and 38.9% (P < 0.01) of the amoxicillin-clavulanate and azithromycin exposed animals, respectively. A total of four intussusceptions were observed in the antibiotic-exposed groups combined whereas no intussusception cases were identified in the control group (P = 0.30). CONCLUSIONS: This is the first study to describe a significant association between antibiotic use and mesenteric adenopathy in any animal species.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed2005

Availability and perceived competence of pediatricians to serve as child protection team medical consultants: a survey of practicing pediatricians.

OBJECTIVES: The effectiveness of multidisciplinary child protection teams has been demonstrated. This study is an attempt to assess the level of this commitment and the perceived competence of primary care pediatricians to provide this service. METHODS: A questionnaire survey was mailed to primary care pediatricians practicing in the state of Alabama. RESULTS: Among respondents who did not consider themselves competent to conduct sexual abuse or physical abuse examinations, 27% and 19%, respectively, were called on to conduct such examinations. Approximately half of respondents expressed a willingness to serve as consultants under a time commitment obligation of less than 2 hours per week or 1 day per month, and under a reimbursement provision of $200 per examination or less. Respondents recognized a need for, and expressed a desire for, more training in this area. CONCLUSIONS: Primary care pediatricians are willing to serve as multidisciplinary child protection team medical consultants if provided appropriate training and support.

Adult↗
PubMed2004

A randomized clinical trial to assess the effects of tympanometry on the diagnosis and treatment of acute otitis media.

OBJECTIVES: Acute otitis media (OM) is the most common indication for the use of antibiotics among children. Otoscopy alone is an imprecise method for the diagnosis of OM, which may lead to inappropriate antibiotic use. We sought to determine whether tympanometry, as an adjunct to otoscopy, would significantly change physician prescribing behavior and whether physicians overprescribe antibiotics for OM, using independently graded tympanometry results as a standard. METHODS: A randomized, clinical trial was conducted among children 6 to 35 months of age who presented to a pediatric emergency department with either fever or upper respiratory infection symptoms. Children were randomized into 2 groups, in which the attending physician evaluated tympanometry results (Tymp Aware) or the attending physician was blinded to the tympanometry findings (Tymp Unaware). Tympanometry curves were graded independently by using a modified version of the Jerger scale. RESULTS: Of the 698 patients enrolled, tympanometry was performed successfully for 99.3%. Antibiotics were prescribed for OM for 27.9% of all patients. No statistically significant difference in antibiotic prescription rates for OM between the Tymp Aware group (28.8%) and the Tymp Unaware group (26.8%) was found. Of all patients for whom antibiotics were prescribed for OM, 14% had normal curves for both ears and 40% had some tympanographic movement bilaterally. CONCLUSIONS: Tympanometry did not seem to change diagnoses or prescribing behavior in the group of physicians studied. Antibiotics were commonly prescribed for presumed OM in the absence of effusions documented with tympanometry.

Acoustic Impedance Tests↗
PubMed2003

Association between antibiotic use and primary idiopathic intussusception.

BACKGROUND: Intussusception is the leading cause of intestinal obstruction in young children. Antibiotics are the most frequently prescribed medication in the pediatric population and have common adverse effects on the gastrointestinal tract. OBJECTIVE: To determine whether a relationship exists between primary idiopathic intussusception and antibiotic drug use. DESIGN: Case-control study. PARTICIPANTS: Ninety-three case patients with intussusception and 353 injury controls younger than 4 years who were seen at the emergency department of the Children's Hospital of Alabama between January 1, 1996, and April 30, 2001, were included. Controls were matched to cases by quarter and year of time of diagnosis, age, and sex. MAIN OUTCOME MEASURES: Odds ratios and 2-sided 95% confidence intervals were estimated using conditional logistic regression. Prevalence of antibiotic use in an age-standardized, representative sample of US children from NHANES III (Third National Health and Nutrition Examination Survey) was used for external comparisons. RESULTS: Antibiotic use within 48 hours of diagnosis was found in 23 cases (25%) and 33 controls (9%) (odds ratio, 4.15; 95% confidence interval, 2.17-7.92; attributable risk, 18.7%). Antibiotic use among US children according to NHANES III was 10.7%. In cases, the beta-lactam class accounted for 78% of all medications used. Cephalosporin use was associated with more than a 20-fold increased risk of intussusception. CONCLUSION: An association between antibiotic drug use and intussusception was identified.

Alabama↗