Schilder Anne G M, Lok Willeke, Rovers Maroeska M
Department of Otorhinolaryngology (KE 04.140.5), Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands.
Int J Pediatr Otorhinolaryngol. 2004 Jan;68(1):29-36. doi: 10.1016/j.ijporl.2003.09.002.
Current opinions regarding the management of acute otitis media (AOM) in children vary across Western countries. With antibiotic resistance rising and more evidence regarding the limited clinical efficacy of antibiotics becoming available, interest in managing AOM other than with antibiotics is renewed.
To compare international rates of antibiotic prescription and surgery for AOM. To provide current evidence regarding the efficacy of various treatment options for AOM and their potential complications.
Qualitative (narrative) review.
The percentage of patients given antibiotics for AOM varies from 31% in The Netherlands to more than 90% in most other Western countries. The 1998 prevalence of penicillin-resistant S. pneumoniae strains, on the other hand, ranges from 3% in The Netherlands to 53% in France. The surgical rate for tympanostomy tubes varies from 2 per 1000 children per year in the United Kingdom to 20 per 1000 in The Netherlands. The benefit of both antibiotic and surgical therapy in AOM appears to be limited, with numbers needed to treat ranging from 8 to 25 for antibiotic therapy, depending on the definition of outcome.
International rates of antibiotic prescription and surgery for AOM vary strongly, which can be explained largely by the lack of uniform evidence-based guidelines. International debates with the aim of overcoming cultural differences regarding the management of otitis media, and of reaching agreement on guidelines on the basis of current evidence are necessary.
西方国家对于儿童急性中耳炎（AOM）的治疗意见各不相同。随着抗生素耐药性的上升以及更多关于抗生素临床疗效有限的证据出现，人们对非抗生素治疗AOM的兴趣再度燃起。
比较AOM的国际抗生素处方率和手术率。提供有关AOM各种治疗方案的疗效及其潜在并发症的当前证据。
定性（叙述性）综述。
AOM患者接受抗生素治疗的比例从荷兰的31%到大多数其他西方国家的90%以上不等。另一方面，1998年耐青霉素肺炎链球菌菌株的流行率在荷兰为3%，在法国为53%。鼓膜置管手术率在英国为每年每1000名儿童中有2例，在荷兰为每1000名中有20例。抗生素和手术治疗在AOM中的益处似乎有限，根据结局的定义，抗生素治疗所需治疗人数为8至25人不等。
AOM的国际抗生素处方率和手术率差异很大，这在很大程度上可以归因于缺乏统一的循证指南。有必要进行国际辩论，以克服中耳炎治疗方面的文化差异，并根据当前证据就指南达成一致。
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