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Supplemental Digital Content is available in the text., Background: Of children with acute otitis media (AOM), 15%–20% present with acute onset ear discharge due to a spontaneous perforation of the tympanic membrane (AOMd). This review aims to quantify the prevalence and antimicrobial resistance (AMR) status of bacteria in children with AOMd in the pneumococcal conjugate vaccine (PCV) era. Methods: Systematic searches were performed in PubMed, EMBASE and Cochrane Library from inception to June 7, 2019. Two reviewers extracted relevant data and assessed risk of bias independently. All English studies reporting any prevalence and/or AMR data of bacterial middle ear isolates from children with AOMd were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal checklist. Results: Of 4088 unique records retrieved, 19 studies (10,560 children) were included. Overall quality was judged good. Streptococcus pneumoniae (median 26.1%, range 9.1%–47.9%), Haemophilus influenzae (median 18.8%, range 3.9%–55.3%), Staphylococcus aureus (median 12.3%, range 2.3%–34.9%) and Streptococcus pyogenes (median 11.8%, range 1.0%–30.9%) were the most prevalent bacteria. In 76.0% (median, range 48.7%–100.0%, 19 studies, 1,429 children) any bacterium was identified. AMR data were sparse and mainly limited to S. pneumoniae. We found no evidence of a clear shift in the prevalence of bacteria and AMR over time. Conclusions: In children with AOMd, S. pneumoniae and H. influenzae are the 2 predominant bacteria, followed by S. aureus and S. pyogenes in the post-PCV era. AMR data are sparse and no clearly change over time was observed. Ongoing surveillance of the microbiology profile in children with AOMd is warranted to guide antibiotic selection and to assess the impact of children’s PCV status.

Background Antibiotics are overused in patients with acute rhinosinusitis (ARS) as it is difficult to identify those who benefit from antibiotic treatment. Aim To develop prediction models for computed tomography (CT)-confirmed ARS and cultureconfirmed acute bacterial rhinosinusitis (ABRS) in adults presenting to primary care with symptoms suggestive of ARS. Design and setting This was a systematic review and individual participant data meta-analysis. Method CT-confirmed ARS was defined as the presence of fluid level or total opacification in any maxillary sinuses, whereas culture-confirmed ABRS was defined by culture of fluid from antral puncture. Prediction models were derived using logistic regression modelling. Results Among 426 patients from three studies, 140 patients (32.9 had CT-confirmed ARS. A model consisting of seven variables: previous diagnosis of ARS, preceding upper respiratory tract infection, anosmia, double sickening, purulent nasal discharge on examination, need for antibiotics as judged by a physician, and C-reactive protein (CRP) showed an optimismcorrected c-statistic of 0.73 (95CI] = 0.69 to 0.78) and a calibration slope of 0.99 (95= 0.72 to 1.19). Among 225 patients from two studies, 68 patients (30.2 had culture-confirmed ABRS. A model consisting of three variables: pain in teeth, purulent nasal discharge, and CRP showed an optimism-corrected c-statistic of 0.70 (95CI = 0.63 to 0.77) and a calibration slope of 1.00 (95= 0.66 to 1.52). Clinical utility analysis showed that both models could be useful to rule out the target condition. Conclusion Simple prediction models for CT-confirmed ARS and culture-confirmed ABRS can be useful to safely reduce antibiotic use in adults with ARS in high-prescribing countries.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects (benefits and harms) of oral antibiotics for otitis media with effusion (OME) in children.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects (benefits and harms) of adenoidectomy, either alone or in combination with ventilation tubes (grommets), for otitis media with effusion (OME) in children.

Additional file 1: Material 1. Short questionnaire after performing both self-tests at home. Material 2. Short questionnaire provided 10 days after test site visit. Material 3. Specimen collection, SARS-CoV-2 diagnostic testing, and SARS-CoV-2 virus culture procedures. Table S1. 2x2 tables for primary and secondary analyses of the molecular reference test – saliva Ag-RDT comparison. Table S2. 2x2 tables for primary and secondary analyses of the molecular reference test – nasal Ag-RDT comparison. Table S3. Follow-up information of participants that were tested again within 10 days after the initial test. Fig. S1. Sensitivities with 95% confidence intervals of the Ag-RDT-molecular reference standard test comparisons at viral load cut-off for infectiousness. Fig. S2. Distribution of viral loads in participants with a positive molecular reference test, stratified by symptomatology at time of sampling. Fig. S3. Distribution of change scores in difficulty of taking a sample and difficulty of reading the test result when comparing difficulty ratings of the saliva Ag-RDT and the nasal Ag-RDT.

Additional file 1 : Suppl. Table S1. Baseline characteristics of the study population included in the PanBio test with less invasive sampling technique evaluation. Suppl. Table S2. Diagnostic accuracy variables of PanBio-molecular reference standard test comparison with less invasive sampling. Values are percentages (95% confidence interval) unless stated otherwise. Suppl. Table S3. Diagnostic accuracy variables of additional secondary analyses of three rapid antigen tests, with different sampling methods. Values are percentages (95% confidence interval) unless stated otherwise. Suppl. Table S4. Two-by-two tables used in primary and secondary analysis to determine diagnostic accuracy parameters of the BD VeritorTM System by Becton Dickinson (���BD-Veritor���) using routine sampling (OP-N). Suppl. Table S5. Two-by-two tables used in primary and secondary analysis to determine diagnostic accuracy parameters of the Roche/SD Biosensor by Roche Diagnostics (���SD-Biosensor���) using routine sampling (NP). Suppl. Table S6. Two-by-two tables used in primary and secondary analysis to determine diagnostic accuracy parameters of the Roche/SD Biosensor by Roche Diagnostics (���SD-Biosensor���) using less invasive sampling (OP-N). Suppl. Table S7. Two-by-two tables used in primary and secondary analysis to determine diagnostic accuracy parameters of the PanBio by Abbot (���PanBio���) using routine sampling (NP). Suppl. Table S8. Two-by-two tables used in primary and secondary analysis to determine diagnostic accuracy parameters of the PanBio by Abbot (���PanBio���) using less invasive sampling (OP-N). Suppl. Table S9. GISAID data contributors acknowledgement table. Suppl. Material 1. Short questionnaire (translated from Dutch). Suppl. Material 2. Specimen collection, SARS-CoV-2 diagnostic testing, and SARS-CoV-2 virus culture procedures.

BACKGROUND: Of children with acute otitis media (AOM), 15%-20% present with acute onset ear discharge due to a spontaneous perforation of the tympanic membrane (AOMd). This review aims to quantify the prevalence and antimicrobial resistance (AMR) status of bacteria in children with AOMd in the pneumococcal conjugate vaccine (PCV) era.METHODS: Systematic searches were performed in PubMed, EMBASE and Cochrane Library from inception to June 7, 2019. Two reviewers extracted relevant data and assessed risk of bias independently. All English studies reporting any prevalence and/or AMR data of bacterial middle ear isolates from children with AOMd were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal checklist.RESULTS: Of 4088 unique records retrieved, 19 studies (10,560 children) were included. Overall quality was judged good. Streptococcus pneumoniae (median 26.1%, range 9.1%-47.9%), Haemophilus influenzae (median 18.8%, range 3.9%-55.3%), Staphylococcus aureus (median 12.3%, range 2.3%-34.9%) and Streptococcus pyogenes (median 11.8%, range 1.0%-30.9%) were the most prevalent bacteria. In 76.0% (median, range 48.7%-100.0%, 19 studies, 1,429 children) any bacterium was identified. AMR data were sparse and mainly limited to S. pneumoniae. We found no evidence of a clear shift in the prevalence of bacteria and AMR over time.CONCLUSIONS: In children with AOMd, S. pneumoniae and H. influenzae are the 2 predominant bacteria, followed by S. aureus and S. pyogenes in the post-PCV era. AMR data are sparse and no clearly change over time was observed. Ongoing surveillance of the microbiology profile in children with AOMd is warranted to guide antibiotic selection and to assess the impact of children's PCV status.

Additional file 2: Supplementary Table 2. Sensitivity analysis 1. Use of resources and mean costs (in €) per child (imputed, two outliers excluded).

Background\ud Prior to introducing pneumococcal conjugate vaccines (PCVs), Streptococcus pneumoniae was most commonly isolated from the middle ear fluid of children with acute otitis media (AOM). Reducing nasopharyngeal colonisation of this bacterium by PCVs may lead to a decline in AOM. The effects of PCVs deserve ongoing monitoring since studies from the post‐PCV era report a shift in causative otopathogens towards non‐vaccine serotypes and other bacteria. This updated Cochrane Review was first published in 2002 and updated in 2004, 2009, 2014, and 2019.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:\ud \ud To assess the effects of non‐steroidal anti‐inflammatory drugs (NSAIDs) for acute sore throat in children and adults.

Objective: We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources: PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods: All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions: Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice: Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.

Recently the revision of the guideline of the Dutch College of General Practitioners on sore throat has been published. Again, one of the key messages is restricting the use of antibiotics. In the Netherlands general practitioners prescribe antibiotics in 50% of cases of tonsillitis. Although there has been a decrease in the number of antibiotic prescriptions for tonsillitis in the last 30 years, they are still being prescribed twice as often as is recommended by the guideline. The beliefs of both patient and doctor play an important role in prescribing and better communication might help to improve the situation. Public campaigns can also help by providing the best knowledge on the effectiveness of antibiotics to the public.