Prescrire Int. 2003 Oct;12(67):184-9.
(1) The best-assessed antibacterial agents in otitis are penicillin V and amoxicillin. No other antibacterial agents are any more effective in clinical trials. (2) In France, amoxicillin seems the best choice because it is still active against pneumococci with diminished sensitivity to penicillin. Also, amoxicillin causes very few serious adverse effects. (3) There is no firm evidence that clavulanic acid makes amoxicillin any more effective. In fact the combination of amoxicillin + clavulanic acid causes more gastrointestinal adverse effects (including potentially severe diarrhoea) than any other antibacterial agent. (4) For patients who are allergic to penicillin, a macrolide such as erythromycin, or cotrimoxazole, appear to be acceptable first-line alternatives. (5) According to a reliable randomised trial, delaying the decision about antibacterial treatment by 72 hours in children with acute otitis media does no harm. If the decision is delayed, three quarters of children avoid antibacterial therapy altogether. (6) Patients get no extra benefit from extending treatment beyond 5 to 7 days. (7) Prolonged treatment, and the use of low doses are risk factors for subsequent carriage of resistant bacteria. (8) There are no comparative trials of antibacterial agents in children at high risk of severe or complicated disease including infants under 3 months old, children with immunosuppression, and those with high fever.
(1) 在治疗中耳炎方面，评估最佳的抗菌药物是青霉素V和阿莫西林。在临床试验中，没有其他抗菌药物更有效。(2) 在法国，阿莫西林似乎是最佳选择，因为它对青霉素敏感性降低的肺炎球菌仍有活性。此外，阿莫西林引起的严重不良反应极少。(3) 没有确凿证据表明克拉维酸会使阿莫西林更有效。事实上，阿莫西林 + 克拉维酸组合比任何其他抗菌药物引起更多的胃肠道不良反应（包括潜在的严重腹泻）。(4) 对于青霉素过敏的患者，大环内酯类药物如红霉素或复方新诺明似乎是可接受的一线替代药物。(5) 根据一项可靠的随机试验，对于急性中耳炎患儿，将抗菌治疗的决定推迟72小时并无危害。如果推迟决定，四分之三的儿童可完全避免抗菌治疗。(6) 治疗超过5至7天，患者不会获得额外益处。(7) 延长治疗时间以及使用低剂量是随后携带耐药菌的危险因素。(8) 对于有严重或复杂疾病高风险的儿童，包括3个月以下婴儿、免疫抑制儿童和高热儿童，没有抗菌药物的比较试验。
