Please Find Two Articles That Help Answer The Clinical Quest ✓ Solved

Please find two articles that help answer the clinical quest

Please find two articles that help answer the clinical question: In children with acute otitis media, are antibiotics effective at reducing symptoms? In two paragraphs, discuss the evidence in relation to the question. Post the article links or PDFs. What do the articles say? How does it help answer the question? Are the articles conflicting or do they reach the same conclusion? Discuss strengths and limitations.

Case Scenario 1 — Acute otitis media

You are a primary care clinician. A young boy recently recovering from a cold now has fever (37.9°C), malaise, irritability, and bilateral bulging red tympanic membranes. Clinical question: In children with acute otitis media, are antibiotics effective at reducing symptoms? Find two relevant articles and, in two paragraphs, discuss the evidence in relation to the question, stating what the articles say, how they answer the question, whether they conflict or agree, and strengths/limitations.

Case Scenario 2 — Inflammatory bowel disease

An 11-year-old girl has intermittent right lower quadrant pain and diarrhea for one year, is small for age; exam shows mild right lower quadrant tenderness. Laboratory results: Hgb 8.6 g/dL, Hct 28%, vitamin B12 68 pg/mL, Meckel scan negative, D-xylose 60 min 8 mg/dL (normal >15–20 mg/dL), 120 min 6 mg/dL (normal >20 mg/dL), lactose tolerance no rise, small bowel series shows multiple segmental constrictions compatible with Crohn disease. She received immunosuppressive therapy with improvement, later required surgery, then recovered with normalization of labs.

Critical thinking questions:

1. Why was this patient placed on immunosuppressive therapy?

2. Why was the Meckel scan ordered?

3. What are the clinical differences and treatment options for ulcerative colitis and Crohn’s disease?

4. What is the prognosis for patients with IBD and what are follow-up recommendations?

Paper For Above Instructions

Part A — Acute Otitis Media: Two Key Articles and Evidence Summary

Selected articles:

  • Hoberman A, Paradise JL, Rockette HE, et al. Treatment of acute otitis media in children. N Engl J Med. 2011;364(2):105–115. https://www.nejm.org/doi/full/10.1056/NEJMoa1002421
  • Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015;(6):CD000219. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000219.pub4/full

Two-paragraph evidence discussion:

Paragraph 1: The randomized trial by Hoberman et al. (2011) evaluated antibiotic therapy (amoxicillin–clavulanate) versus placebo in young children with acute otitis media (AOM) and found that early antibiotic therapy produced a higher rate of clinical improvement and more rapid resolution of otalgia and fever compared with placebo in the studied cohort (Hoberman et al., 2011). The study importantly included children with more severe presentations (e.g., bilateral AOM, high fever, younger age), and showed a statistically significant benefit in symptom reduction at early follow-up points. The trial provides high-quality evidence supporting antibiotic benefit in symptomatic relief for selected younger children or those with more severe disease (Hoberman et al., 2011).

Paragraph 2: The Cochrane systematic review (Venekamp et al., 2015) pooled multiple randomized trials and concluded that antibiotics confer a modest overall benefit in symptom resolution at 2–7 days and reduce the risk of complications (such as mastoiditis) but also increase adverse events (such as diarrhea and rash). The Cochrane authors emphasize that the absolute benefit is greater in children <2 years of age, those with bilateral AOM, or with otorrhea; conversely, for older children or those with mild unilateral disease, the benefit is small and watchful waiting is reasonable (Venekamp et al., 2015). Taken together, these two high-quality sources agree that antibiotics can reduce short-term symptoms in many children with AOM, especially in high-risk groups, while also noting harms and the small absolute benefit in milder cases.

How the articles answer the clinical question: Both articles directly address whether antibiotics reduce symptoms in children with AOM. Hoberman et al. provides trial-level evidence of symptomatic benefit in a population biased toward younger/more severe cases, while the Cochrane review synthesizes broader trial data and quantifies the magnitude of benefit and harms across ages and severities (Hoberman et al., 2011; Venekamp et al., 2015). They do not conflict; rather they are complementary: the trial shows benefit in sicker/younger children and the review shows modest pooled benefit with heterogeneity by age and disease severity. Strengths include randomized design and systematic synthesis; limitations include varied inclusion criteria across trials, differing antibiotic regimens, and evolving resistance patterns since older trials. Clinically, the evidence supports an individualized approach: antibiotics for young children, bilateral disease, or severe symptoms; shared decision-making/watchful waiting for older children with mild unilateral AOM (AAP guideline) (American Academy of Pediatrics, 2013).

Links / PDFs

Hoberman NEJM 2011 (full text): https://www.nejm.org/doi/full/10.1056/NEJMoa1002421

Cochrane review 2015 (CDSR): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000219.pub4/full

Part B — Inflammatory Bowel Disease: Critical Thinking Answers

Question 1 — Why was this patient placed on immunosuppressive therapy?

Answer: The child’s history, imaging (segmental small-bowel strictures), malabsorption (low D-xylose), vitamin B12 deficiency, anemia, and chronic symptoms are consistent with active Crohn disease causing inflammation, ulceration, and impaired absorption. Immunosuppressive therapy (e.g., corticosteroids, azathioprine/6-mercaptopurine, methotrexate, biologics like anti-TNF agents) is indicated to induce and maintain remission, reduce inflammation, heal mucosa, correct malabsorption, and promote growth in pediatric patients (Torres et al., 2017; Turner et al., 2018). The child’s severe anemia and impaired growth justify aggressive medical therapy to control disease and restore nutritional status.

Question 2 — Why was the Meckel scan ordered?

Answer: A Meckel scan (technetium-99m pertechnetate) detects ectopic gastric mucosa in a Meckel diverticulum, which can cause painless bleeding or chronic iron-deficiency anemia in children. Given this child’s anemia and chronic gastrointestinal symptoms, a Meckel scan was ordered to exclude a Meckel diverticulum as a source of bleeding or chronic blood loss contributing to anemia. The negative result helped focus the diagnosis on small-bowel Crohn disease rather than surgical causes of bleeding.

Question 3 — Clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease

Answer: Ulcerative colitis (UC) is limited to the colon with continuous mucosal inflammation starting from the rectum; Crohn’s disease (CD) can involve any part of the GI tract with transmural, segmental ("skip") lesions, fistulae, and strictures (Torres et al., 2017). Medical therapy overlaps but differs: UC is treated with 5-ASA agents for mild disease, corticosteroids for flares, immunomodulators and biologics for moderate–severe disease, and colectomy is curative. CD treatment includes nutritional therapy (especially in children), corticosteroids for induction, immunomodulators (azathioprine, methotrexate), biologics (anti-TNF, anti-integrin), and surgery for strictures/complications; surgery is not curative and recurrence can occur (Torres et al., 2017; Rubin et al., 2019).

Question 4 — Prognosis and follow-up recommendations

Answer: Prognosis depends on disease phenotype, severity, growth in pediatric patients, and response to therapy. Many patients achieve remission with medical therapy, but Crohn’s disease often follows a relapsing course with risk of complications (stricturing, fistulae) and need for surgery (Torres et al., 2017). Follow-up includes growth and development monitoring in children, regular lab surveillance (CBC, CRP, nutritional markers including B12, iron, folate), colonoscopic assessment for mucosal healing, vaccination review, bone health monitoring, and timely escalation of therapy when needed. Postoperative patients require surveillance for recurrence; multidisciplinary care and transition planning to adult services are important (ECCO/ESPGHAN guidelines).

References

  • Hoberman A, Paradise JL, Rockette HE, et al. Treatment of acute otitis media in children. N Engl J Med. 2011;364:105–115. https://www.nejm.org/doi/full/10.1056/NEJMoa1002421
  • Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015;(6):CD000219. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000219.pub4/full
  • American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Clinical practice guideline: Diagnosis and management of acute otitis media. Pediatrics. 2013;131:e964–e999. https://pediatrics.aappublications.org/content/131/3/e964
  • Rosenfeld RM, Wetmore RF, Schwartz SR, et al. Clinical practice guideline: Otitis media (acute) — diagnosis and management. Otolaryngol Head Neck Surg. 2013;149(2S):S1–S67. https://journals.sagepub.com/doi/10.1177/0194599813514788
  • Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn's disease. Lancet. 2017;389(10080):1741–1755. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31711-1/fulltext
  • Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of pediatric Crohn’s disease: ECCO-ESPGHAN guidelines. J Pediatr Gastroenterol Nutr. 2018;66(2): 242–264. https://academic.oup.com/ecco-jcc/article/13/6/742/4099268
  • Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: Ulcerative colitis in adults. Am J Gastroenterol. 2019;114(3):384–413. https://journals.lww.com/ajg/Fulltext/2019/03000/ACG_Clinical_Guideline__Ulcerative_Colitis_in_Adults.20.aspx
  • Williams RS, Rowe S. Meckel's diverticulum: technetium-99m pertechnetate scintigraphy in children. Pediatr Radiol. 2006;36(5):427–430. DOI:10.1007/s00247-005-0119-4
  • Le H, Nguyen GC. Iron-deficiency anemia in inflammatory bowel disease: pathophysiology and management. Curr Gastroenterol Rep. 2019;21:35. https://link.springer.com/article/10.1007/s11894-019-0718-9
  • ECCO/ESPGHAN guidelines on postoperative Crohn’s disease and monitoring. J Crohns Colitis. 2018;12(12): 1209–1226. https://academic.oup.com/ecco-jcc/article/12/12/1209/5163840

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