Thorøe J, Lous J
Aarhus Universitet, Institut og Forskningsenheden for Almen Medicin.
Ugeskr Laeger. 1999 Sep 27;161(39):5413-7.
Antibiotic treatment of acute otitis media is controversial. The questions are when to treat, with which antibiotic, and for how long? Within the last years three reviews attempting to discuss these questions have been published. All three found only a marginal effect of antibiotic treatment. The effect was less earache after the first day. The meta-analyses showed that between eight and 22 children had to be treated before one had any benefit of the treatment. The randomized studies did not find a greater effect of amoxicillin than of penicillin. The marginal effect of antibiotics on acute otitis media supports watchful waiting and individualized care and follow-up. There is a need for well-organized, randomized, placebo-controlled trials including the youngest children and the more severe cases of acute otitis media where the effect of antibiotic treatment may turn out to be most beneficial.
急性中耳炎的抗生素治疗存在争议。问题在于何时治疗、使用何种抗生素以及治疗多久？在过去几年里，已发表了三篇试图讨论这些问题的综述。这三篇综述均发现抗生素治疗仅有微弱效果。其效果是第一天后耳痛减轻。荟萃分析表明，在一名患者从治疗中获益之前，需要治疗8至22名儿童。随机研究未发现阿莫西林比青霉素有更大效果。抗生素对急性中耳炎的微弱效果支持观察等待以及个体化护理和随访。有必要开展组织良好、随机、安慰剂对照的试验，纳入最小的儿童以及急性中耳炎病情较重的病例，因为在这些病例中抗生素治疗的效果可能最为有益。
