Lancaster General Hospital, Lancaster General Research Institute, 555 N Duke St, Lancaster, PA 17604, USA.
Pediatrics. 2010 Feb;125(2):214-20. doi: 10.1542/peds.2009-1115. Epub 2010 Jan 25.
Observation without initial antibiotic therapy was accepted as an option for acute otitis media (AOM) management in the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline. The guideline also recommended amoxicillin as the first-line treatment for most children, and analgesic treatment to reduce pain if it was present. Our objective was to compare the management of AOM after publication of the 2004 guideline.
We analyzed the National Ambulatory Medical Care Survey, 2002-2006 (N = 1114), which occurred in US physicians' offices. The patients were children aged 6 months to 12 years who were diagnosed with AOM. The time comparisons were the 30-month periods before and after the guideline. The main outcome was the encounter rate at which no antibiotic-prescribing was reported. Secondary outcomes were the identification of factors associated with encounters at which no antibiotic-prescribing was reported and antibiotic- and analgesic-prescribing rates.
The rate of AOM encounters at which no antibiotic-prescribing was reported did not change after guideline publication (11%-16%; P = .103). Independent predictors of an encounter at which no antibiotic-prescribing was reported were the absence of ear pain, absence of reported fever, and receipt of an analgesic prescription. After guideline publication, the rate of amoxicillin-prescribing increased (40%-49%; P = .039), the rate of amoxicillin/clavulanate-prescribing decreased (23%-16%; P = .043), the rate of cefdinir-prescribing increased (7%-14%; P = .004), and the rate of analgesic-prescribing increased (14%-24%; P = .038).
Although management of AOM without antibiotics has not increased after the publication of the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline, children who did not receive antibiotics were more likely to have mild infections. In accordance with the guideline, the prescribing of amoxicillin and analgesics has increased. Contrary to the guideline, the prescribing of amoxicillin/clavulanate has decreased, whereas the prescribing of cefdinir has increased.
2004 年美国儿科学会和美国家庭医生学会临床实践指南接受了在急性中耳炎（AOM）管理中观察而不进行初始抗生素治疗的选择。该指南还建议阿莫西林作为大多数儿童的一线治疗药物，如果有疼痛，应进行镇痛治疗以减轻疼痛。我们的目的是比较 2004 年指南发布后的 AOM 管理。
我们分析了 2002-2006 年在美国医生办公室进行的全国门诊医疗调查（N = 1114），这些患者是年龄在 6 个月至 12 岁之间被诊断为 AOM 的儿童。时间比较是指南发布前后的 30 个月。主要结果是报告未开抗生素处方的就诊率。次要结果是确定与未开抗生素处方就诊相关的因素以及抗生素和镇痛药处方率。
指南发布后，未开抗生素处方的 AOM 就诊率并未改变（11%-16%；P =.103）。未开抗生素处方就诊的独立预测因素是无耳部疼痛、无发热报告和接受镇痛药处方。指南发布后，阿莫西林的处方率增加（40%-49%；P =.039），阿莫西林/克拉维酸的处方率降低（23%-16%；P =.043），头孢地尼的处方率增加（7%-14%；P =.004），镇痛药的处方率增加（14%-24%；P =.038）。
尽管 2004 年美国儿科学会和美国家庭医生学会临床实践指南发布后，不使用抗生素治疗 AOM 的情况并未增加，但未接受抗生素治疗的儿童更有可能患有轻度感染。根据指南，阿莫西林和镇痛药的处方增加了。与指南相反，阿莫西林/克拉维酸的处方减少了，而头孢地尼的处方增加了。
