Little Paul, Gould Clare, Moore Michael, Warner Greg, Dunleavey Joan, Williamson Ian
Community Clinical Sciences (Primary Medical Care Group), University of Southampton, Aldermoor Health Centre, Southampton SO15 6ST.
BMJ. 2002 Jul 6;325(7354):22; discussion 22. doi: 10.1136/bmj.325.7354.22.
To identify which children with acute otitis media are at risk of poor outcome and to assess benefit from antibiotics in these children.
Secondary analysis of randomised controlled trial cohort.
Primary care.
315 children aged 6 months to 10 years.
Immediate or delayed (taken after 72 hours if necessary) antibiotics.
Predictors of short term outcome: an episode of distress or night disturbance three days after child saw doctor.
Distress by day three was more likely in children with high temperature (adjusted odds ratio 4.5, 95% confidence interval 2.3 to 9.0), vomiting (2.6,1.3 to 5.0), and cough (2.0, 1.1 to 3.8) on day one. Night disturbance by day three was more likely with high temperature 2.4 (1.2 to 4.8), vomiting (2.1,1.1 to 4.0), cough (2.3,1.3 to 4.2), and ear discharge (2.1, 1.2 to 3.9). Among the children with high temperature or vomiting, distress by day three was less likely with immediate antibiotics (32% for immediate v 53% for delayed, chi2=4.0; P=0.045, number needed to treat 5) as was night disturbance (26% v 59%, chi2=9.3; P=0.002; number needed to treat 3). In children without higher temperature or vomiting, immediate antibiotics made little difference to distress by day three (15% v 19%, chi2=0.74; P=0.39) or night disturbance (20% v 27%, chi2=1.6; P=0.20). Addition of cough did not significantly improve prediction of benefit.
In children with otitis media but without fever and vomiting antibiotic treatment has little benefit and a poor outcome is unlikely.
确定哪些患有急性中耳炎的儿童预后不良风险较高，并评估这些儿童使用抗生素的益处。
对随机对照试验队列进行二次分析。
初级保健机构。
315名年龄在6个月至10岁之间的儿童。
立即使用或延迟使用（必要时在72小时后使用）抗生素。
短期预后的预测因素：患儿看医生三天后出现痛苦发作或夜间睡眠受扰。
第一天出现高烧（校正比值比4.5，95%置信区间2.3至9.0）、呕吐（2.6，1.3至5.0）和咳嗽（2.0，1.1至3.8）的儿童在第三天更有可能出现痛苦。第三天夜间睡眠受扰在出现高烧（2.4，1.2至4.8）、呕吐（2.1，1.1至4.0）、咳嗽（2.3，1.3至4.2）和耳漏（2.1，1.2至3.9）的儿童中更常见。在出现高烧或呕吐的儿童中，立即使用抗生素在第三天出现痛苦的可能性较小（立即使用抗生素为32%，延迟使用为53%，χ²=4.0；P=0.045，需治疗人数为5），夜间睡眠受扰的情况也是如此（26%对59%，χ²=9.3；P=0.002；需治疗人数为3）。在没有高烧或呕吐的儿童中，立即使用抗生素对第三天出现痛苦（15%对19%，χ²=0.74；P=0.39）或夜间睡眠受扰（20%对27%，χ²=1.6；P=0.20）影响不大。增加咳嗽因素并不能显著改善获益预测。
对于患有中耳炎但无发热和呕吐的儿童，抗生素治疗益处不大，且预后不良的可能性较小。
