Casey Janet R
Elmwood Pediatric Group, Rochester, NY 14620, USA.
Postgrad Med. 2005 Dec;118(6 Suppl Emerging):32-3, 24-31. doi: 10.3810/pgm.12.2005.suppl42.220.
Acute otitis media (AOM) is treated with antibiotics in the United States, but the changing distribution of bacterial pathogens that cause the disorder can present physicians with several challenges. Most physicians treat AOM empirically, and their treatment choice should target Streptococcus pneumonia, nontypeable Haemophilus influenzae, and Moraxella catarrhalis, as those bacteria are most often isolated in AOM. First-line treatment for new onset AOM remains amoxicillin (80-90 mg/kg/d, divided twice daily). For persistent or recurrent AOM, guidelines recommend high-dose amoxicillin-clavulanate, cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone. Improved diagnosis and optimizing the choice of therapy by considering in vitro and in vivo efficacy of the different antibiotics will improve patient outcomes. Improved patient outcomes will result in fewer AOM episodes, decreased antibiotic resistance, and reduced direct and indirect health care costs.
在美国，急性中耳炎（AOM）采用抗生素治疗，但导致该疾病的细菌病原体分布变化给医生带来了诸多挑战。大多数医生采用经验性治疗AOM，其治疗选择应针对肺炎链球菌、非分型流感嗜血杆菌和卡他莫拉菌，因为这些细菌在AOM中最常分离出来。新发AOM的一线治疗仍然是阿莫西林（80 - 90mg/kg/天，分两次服用）。对于持续性或复发性AOM，指南推荐使用高剂量阿莫西林 - 克拉维酸、头孢地尼、头孢丙烯、头孢泊肟、头孢呋辛或头孢曲松。通过考虑不同抗生素的体外和体内疗效来改进诊断并优化治疗选择，将改善患者预后。改善患者预后将减少AOM发作次数、降低抗生素耐药性，并减少直接和间接医疗保健成本。
