Van Zuijlen D A, Schilder A G, Van Balen F A, Hoes A W
Department of Otorhinolaryngology, University Medical Center Utrecht, The Netherlands.
Pediatr Infect Dis J. 2001 Feb;20(2):140-4. doi: 10.1097/00006454-200102000-00004.
Operating on the principle that most acute otitis media (AOM) episodes resolve without antibiotics, doctors in the Netherlands usually manage AOM in children with initial observation. Prescription of antibiotics is limited to children with a complicated course of AOM and those categorized as high risk. Consequently only 31% of patients with AOM receives antibiotics, compared with >90% in most other countries.
To substantiate the suggestion that this restrictive use of antibiotics leads to a higher incidence of acute mastoiditis.
A comparative study across several European countries, Canada, Australia and the United States was performed in the period 1991 to 1998. The incidence rate of acute mastoiditis was defined as the total number of patients age 14 years and younger discharged from all hospitals with the primary diagnosis of acute mastoiditis, during a specified period (usually 5 years), divided by the number of person years (py) in that same age range and period. The latter was calculated by totaling the midyear population estimate of children age 14 years and younger of each year. The 95% confidence intervals and incidence rate ratios were calculated to compare the observed rates.
The incidence rate of acute mastoiditis in the Netherlands, with a low antibiotic prescription rate for AOM, was 3.8/100,000 py; in Norway and Denmark, with high prescription rates, the incidence rate was comparable at 3.5/100,000 py and 4.2/100,000 py, respectively. In all other countries with very high prescription rates, incidence rates were considerably lower, ranging from 1.2 to 2.0/100,000 py. The incidence rate in the Netherlands was about twice that in the United States (rate ratio, 0.5).
The incidence rate of acute mastoiditis in the Netherlands is higher than in many countries with higher antibiotic prescription rates. Although the potential benefits of restricted use of antibiotics (i.e. cost reduction, fewer side effects from antibiotics and less antimicrobial resistance) are beyond dispute, such strategy may be associated with a somewhat higher incidence of acute mastoiditis.
基于大多数急性中耳炎（AOM）发作无需使用抗生素即可痊愈的原则，荷兰的医生通常对儿童AOM采取初始观察的管理方式。抗生素的处方仅限于AOM病程复杂的儿童以及被归类为高危的儿童。因此，只有31%的AOM患者接受抗生素治疗，而在大多数其他国家这一比例超过90%。
证实这种抗生素的限制性使用会导致急性乳突炎发病率更高这一观点。
在1991年至1998年期间对多个欧洲国家、加拿大、澳大利亚和美国进行了一项比较研究。急性乳突炎的发病率定义为在特定时期（通常为5年）内，所有医院中以急性乳突炎作为主要诊断出院的14岁及以下患者总数，除以同一年龄范围和时期内的人年数（py）。后者通过计算每年14岁及以下儿童的年中人口估计总数得出。计算95%置信区间和发病率比以比较观察到的发病率。
荷兰AOM抗生素处方率较低，其急性乳突炎发病率为3.8/100,000 py；挪威和丹麦抗生素处方率较高，发病率分别为3.5/100,000 py和4.2/100,000 py，二者相当。在所有其他抗生素处方率非常高的国家，发病率则低得多，范围在1.2至2.0/100,000 py之间。荷兰的发病率约为美国的两倍（发病率比为0.5）。
荷兰急性乳突炎的发病率高于许多抗生素处方率较高的国家。尽管抗生素限制性使用的潜在益处（即成本降低、抗生素副作用减少和抗菌耐药性降低）无可争议，但这种策略可能与急性乳突炎发病率略有升高有关。
