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Key Action Statement Profile: KAS 3D

Aggregate evidence qualityGrade B
Benefits Initial antibiotic treatment: Slightly increased likelihood of more rapid resolution of symptoms; slightly increased likelihood of resolution of AOM. Initial observation: Decreased use of antibiotics; decreased adverse effects of antibiotics; decreased potential for development of bacterial resistance. 
Risks, harms, cost Initial antibiotic treatment: Adverse events attributable to antibiotics such as diarrhea, rashes, and allergic reactions. Overuse of antibiotics leads to increased bacterial resistance. Initial observation: Possibility of needing to start antibiotics in 48 to 72 h if the patient continues to have symptoms. Minimal risk of adverse consequences of delayed antibiotic treatment. Potential increased phone calls and doctor visits. 
Benefits-harms assessment Slight degree of benefit of initial antibiotics over harm. 
Value judgments Observation is an option as the benefits and harms approach balance. 
Role of patient preference Joint decision-making with the family is essential before choosing observation. 
Intentional vagueness Joint decision-making is highly variable from family to family. 
Exclusions None 
Strength Recommendation. 
Aggregate evidence qualityGrade B
Benefits Initial antibiotic treatment: Slightly increased likelihood of more rapid resolution of symptoms; slightly increased likelihood of resolution of AOM. Initial observation: Decreased use of antibiotics; decreased adverse effects of antibiotics; decreased potential for development of bacterial resistance. 
Risks, harms, cost Initial antibiotic treatment: Adverse events attributable to antibiotics such as diarrhea, rashes, and allergic reactions. Overuse of antibiotics leads to increased bacterial resistance. Initial observation: Possibility of needing to start antibiotics in 48 to 72 h if the patient continues to have symptoms. Minimal risk of adverse consequences of delayed antibiotic treatment. Potential increased phone calls and doctor visits. 
Benefits-harms assessment Slight degree of benefit of initial antibiotics over harm. 
Value judgments Observation is an option as the benefits and harms approach balance. 
Role of patient preference Joint decision-making with the family is essential before choosing observation. 
Intentional vagueness Joint decision-making is highly variable from family to family. 
Exclusions None 
Strength Recommendation. 
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