By Dr. Seema Khaneja,
MD, FAAP
Integrative Homeopathy
Author Disclosures: Dr. Khaneja has done homeopathic consulting work, including for Hyland’s. This article was peer reviewed by two pharmacists with no conflicts of interest.
Universal Program Number: 401-000-10-002-H01-P
Activity Type: Knowledge-based
Initial Release Date: Feb. 2, 2010
Planned Expiration Date: Feb. 2, 2013
This program is worth one contact hour
(0.1 CEUs).
Target Audience
Pharmacists in community-based practice.
Program Goal
To improve the pharmacist’s ability to counsel patients on the management of acute otitis media in children, including homeopathic treatments.
Learning Objectives
Upon completion of this program, the pharmacist should be able to:
1. Describe the incidence, prevalence, diagnosis and natural history of acute otitis media in children.
2. Recall the role of the wait-and-see prescrip-
tion (WASP) and the judicious use of antibi-
otics in the management of AOM based on
evidence-based clinical practice guidelines.
3. Explain the basic principles of homeopathy.
4. Differentiate homeopathic products from
other herbal OTC medications.
5. Recall the role of single and combination homeopathic products in the management of AOM.
6. Counsel patients, parents or other caregivers on the use of homeopathic treatments for patients with AOM.
To obtain credit: A minimum test score of 70% is needed to obtain a statement of credit. Submit your answers online at CEdrugstorenews.com, and receive your statement of credit in your CE account folder immediately. Submit by mail or fax using the answer sheet found in your issue, and receive your printed statement of credit within seven days of receipt.
Questions regarding statements of credit and other customer service issues should be directed to Angela Sims at (800) 933-9666. If you are a paid enrollee, there is no cost to participate in this lesson. The fee for participants who are not enrolled is $13.95.
TO LINK DIRECTLY TO THIS LESSON, VISIT: CEdrugstorenews.com/40100010002H01
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Accreditation Council for Pharmacy Education
as a provider of continuing pharmacy education.
Acute otitis media is the most common reason for physician office visits among preschool-aged children and a significant cause for antibiotic prescriptions for children. 1 The management of AOM creates a considerable cost and burden to the healthcare system, and also can greatly impact a family in terms of time lost from school and work. 2
Recent evidence-based clinical practice guidelines published by the American Academy of Pediatrics, or AAP, and the American Academy of Family Physicians, or AAFP, encourage healthcare practitioners caring for children to consider the “wait-and-see prescription,” or WASP — observation for 48 to 72 hours without the use of antibiotics in certain children based on diagnostic certainty, age, illness severity and assurance of follow-up. 2, 3 In these cases, caregivers often may seek alternative options that are safe, effective and readily available.
Homeopathy is a system of
medicine that has been used
worldwide safely and success-
fully for more than 200 years. In
addition, homeopathic medica-
tions are regulated by the Food
and Drug Administration and
are widely available as over-the-
counter medications. Parents
given a “wait-and-see prescrip-
tion” for their children with
AOM are likely to turn to their
pharmacists for advice on other
available management options.
Pharmacists, with their back-
ground and clinical training,
are in an excellent position to
appropriately counsel caregiv-
ers about how to safely and ef-
fectively manage many cases of
AOM using homeopathy.
In 2000, there were 16 million office visits made for AOM to office-based physicians, and there were 13 million antibiotic prescriptions written. 2 More recent national data have shown that the number of office visits with otitis media as the primary diagnosis for children under 18 years of age has declined about 13% from 1997 to 2004.4 The largest decline has occurred for children under 3 years of age; comparing annual otitis media rates from 1994 to 1999, to rates from 2002 to 2003, there was a significant decline of 20% among children under 2 years of age. 4 Annual, estimated, national, direct medical expenditures for acute otitis media-related ambulatory visits and antibiotic prescriptions for children under 2 years of age decreased from an average of $1.41 billion during 1997 to 1999, to $0.95 billion in 2004, which was a 32.3% reduction. 1
Numerous studies have shown that the common pathogens in AOM are Streptococcus pneumoniae, nontypeable Haemophilus influenzae and Moraxella catarrhalis, with Streptococcus pneumoniae being the most common bacterial cause of AOM, accounting for 30% to 50% of episodes. 1, 2 Viruses, including respiratory syncytial virus, rhinovirus, coronavirus, parainfluenza, adenovirus and enterovirus, have been found to cause 5% to 22% of cases of OM. 2 In approximately 16% to 25% of cases of AOM, no viral or bacterial pathogen can be detected. 2
Introduction of the pneumococcal conjugate vaccine, which was licensed for routine infant administration in 2000, could partially explain the decline in office visits and antibiotic prescriptions for AOM. 4, 5 Other factors, such as AAP/AAFP 2004 Clinical Practice Guidelines to reduce inappropriate antibiotic use, also might have contributed to the observed trend. 1
The prevalence of OM is greatest in children under 3 years of age. 4 Before 36 months of age, 83% of children experience one episode of AOM. 1 There also is an increased incidence around 5 years of age, which is when most children are likely to begin full-time school attendance, and thus be more likely to have greater exposure to the microbial agents that cause AOM. 6
Interestingly, while AOM is one of the most common infections for which antibiotic prescriptions are written, placebo-controlled trials over the past 30 years have shown that most children do well without any adverse sequalae, even without antibiotics. 2 These studies estimated that between seven and 20 children must be treated with antibiotics for one child to derive benefit. 2 In terms of the timing of the natural resolution of AOM, two-thirds of children with uncomplicated AOM recover from pain and fever within 24 hours of diagnosis without any antibiotic treatment. 7 More than 80% will recover within one to seven days without any antibiotic treatment. 7 The most common complications of AOM are mastoiditis and meningitis, but studies demonstrate that the
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