Niv A, Nash M, Peiser J, Dagan R, Einhorn M, Leiberman A, Fliss D M
Department of Otolaryngology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Int J Pediatr Otorhinolaryngol. 1998 Nov 15;46(1-2):9-13. doi: 10.1016/s0165-5876(98)00110-4.
Children with acute mastoiditis with periosteitis are conventionally hospitalized for parenteral antibiotics and/or surgical treatment. However, if possible, effective and safe outpatient treatment is desirable. During a 36-month period, outpatient parenteral antibiotic therapy (once daily i.m. ceftriaxone) was evaluated in 32 children with acute mastoiditis, with clinical evidence of periosteitis. Inclusion criteria included otomicroscopic evidence of acute otitis media (AOM), displacement of the pinna, retroauricular swelling, erythema and tenderness. The treatment consisted of wide myringotomy and administration of i.m. antibiotics. Daily visits, by a combined team of an otolaryngologist and pediatric infectious disease specialist, were considered essential. Fourteen children (43%) were treated initially in the hospital (and subsequently as outpatients) and 18 (57%) children were treated entirely as outpatients. Mean duration of outpatient treatment was 7 days (range: 4-10). The overall clinical cure rate was 96.8%. One child underwent simple mastoidectomy. No serious side effects were observed. Our data suggests that many children with acute mastoiditis with periosteitis can be managed successfully and safely as outpatients by a combined team of otolaryngologists and infectious disease specialists.
患有急性乳突炎伴骨膜炎的儿童通常需住院接受肠胃外抗生素治疗和/或手术治疗。然而，若有可能，有效且安全的门诊治疗更佳。在36个月期间，对32例患有急性乳突炎且有骨膜炎临床证据的儿童进行了门诊肠胃外抗生素治疗（每日一次肌肉注射头孢曲松）评估。纳入标准包括急性中耳炎（AOM）的耳镜检查证据、耳廓移位、耳后肿胀、红斑和压痛。治疗包括广泛鼓膜切开术和肌肉注射抗生素。由耳鼻喉科医生和儿科传染病专家组成的联合团队进行每日查房被认为至关重要。14名儿童（43%）最初在医院接受治疗（随后转为门诊治疗），18名儿童（57%）完全作为门诊患者接受治疗。门诊治疗的平均持续时间为7天（范围：4 - 10天）。总体临床治愈率为96.8%。1名儿童接受了单纯乳突切除术。未观察到严重副作用。我们的数据表明，许多患有急性乳突炎伴骨膜炎的儿童可由耳鼻喉科医生和传染病专家组成的联合团队成功且安全地作为门诊患者进行治疗。
