Introduction Nursing as a Profession

Running head: PICOT ANALYSIS
PICOT ANALYSIS
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PICOT ANALYSIS1
Introduction
Nursing as a profession requires the approach of theoretical knowledge in practical
experience for the delivery of quality care and safety. This essay will explain the practical
implementation of PICOT idea in medical scenarios such as the use of antibiotic and non-
antibiotic medicines for acute otitis media. It will have a systematic review of the evidence based
research paper that will discuss about the use of such medication in acute otitis media in
children. The argument is about the use of antibiotic versus the use of non-antibiotic medications
used in the condition of acute otitis media, which is an infection common to children. In most
scenarios, medical experts provide antibiotics but there is a controversy between different
researchers in this regard. The medical community has several fundamental issues about the
antimicrobial management of acute otitis media in children. It is an infection in the ear, which
occurs in the area behind the eardrum known as middle ear that gets infected and inflamed.
Children show few symptoms such as fussiness and intense crying during infancy, clutching the
ear due to pain when they are a toddler, and complaints about ear pain during middle childhood
(Qureishi et al., 2014). This paper will define the PICOT question related to the topic of
discussion.
Discussion
The PICOT question means population (P), Intervention (I), Comparison/Control (C),
Outcome (O) and Time (T). According to this framework, the question of this discussion will be
defined as children with acute otitis media (P), implementation of antibiotic (I), comparison
between both type of medications (C), efficiency during the period of symptoms (O) and the
duration of both the treatments (T) (Elias et al., 2014). This clinical question will have a

PICOT ANALYSIS2
systematic review that will highlight the better option between antibiotic or non-antibiotic
management in acute otitis media.
The use of antibiotic management is prevalent in the treatment of acute otitis media in
children due to several reasons. The major reason is the involvement of bacteria in this infection
because the etiology suggests that viruses play a significant role in the inflammation of the
middle ear. The pathophysiology explains that the viruses are the reason the treatment gets
obstructed due to which the bacteria is not found in the middle ear fluid. The strains of bacteria
change during every research and the most common bacteria found is Streptococcus pneumoniae
in 42% of the cases. Haemophilus influenza is found 31% cases, and Moraxella catarrhalis is
found in 16% of the cases. This suggests that the antibiotic treatment will be effective in this
treatment because this medication focuses on microbial organism such as bacteria and virus. The
first line of treatment used in children with acute otitis media is amoxicillin, which is an
antibiotic with no beta lactam allergies (Martin et al., 2014). Not many medicines are able to
show positive effects like amoxicillin and this proves that antibiotics are helpful for the
management of this infection. The advantages of this medicine is that it penetrates to the middle
of the ear effectively, comes under a budget that is economical and has a low microbial
spectrum. It is an oral drug that is beneficial for the treatment if given in the required dose and it
works against penicillin resistant S pneumonia. The recommended dose for this medicine is 75
mg/kg/day to 90 mg/kg/day for a child. This dose guarantees accurate treatment for the pain
caused in children due to this infection. In some cases, children suffer from hypersensitivity from
amoxicillin and during this situation they can be given a macrolide (clarithromycin or
azithromycin). Even after this solution if the child is not able to overcome the hypersensitivity
then they should be prescribed second-generation cephalosporins, which is also an antibiotic.

PICOT ANALYSIS3
Amoxicillin is effective in majority of the cases but sometimes it can refuse to work depending
on the drug reaction or the metabolism of the child, in such situations amoxicillin clavulanate 90
mg/kg/day is recommended. Antibiotic treatment can decrease the symptoms in 1-2 days and the
resolving of the disease can be effective after 2-3 days. When the antibiotic treatment is not
working then the type of antimicrobial should be changed, which targets both beta lactamase
producing organisms and penicillin resistant S pneumonia. An antimicrobial treatment is
effective when the child less than 2 years of age is given a 10-day course of this medication.
However, antimicrobial treatment should be stopped if the child is suffering from antibiotic
medicine related side effects (Nokso-Koivisto, Marom & Chonmaitree, 2015).
Another form of medicines that are widely used in the medical filed is the non-antibiotic
medications. The treatment of acute otitis media can be done without antibiotic medications
because this infection has a spontaneous recovery rate that does not require severe medications.
It is difficult to predict, which medication is required in certain cases due to the spontaneity in
the prognosis of this infection. Few researchers recommend that a wait period 48-72 hours
should be observed before starting any type of antimicrobial therapy. Non-microbial ear drops
are also preferred for the treatment of this infection but in severe cases doctors suggest surgical
treatments. Some of the surgical procedures are adenoid removal and ear tube insertion, in which
the adenoid is removed, which increases the inflammation and infection in the ears, and ear tubes
are inserted in the ear for the infected air and fluid to drain from the middle ear (Marom et al.,
2016). Non-antibiotic medications are beneficial for this treatment of this disease because
antimicrobials are the reason for diarrhea, with complications such as anaphylaxis and Stevens-
Johnson syndrome, which can be life threatening. It is also said that maximum use of antibiotics
can be the reason for increasing antibiotic-resistant organisms. Antimicrobial resistance is the