Université Libre de Bruxelles, Brussels, Belgium.
Lancet Infect Dis. 2010 Mar;10(3):195-203. doi: 10.1016/S1473-3099(10)70012-8.
An international group of multidisciplinary experts on middle-ear and paediatric infections met to explore where consensus exists on the management of acute otitis media. After informal discussions among several specialists of paediatric infectious disease, the group was expanded to include a larger spectrum of professionals with complementary expertise in middle-ear disease. Acute otitis media is a very common bacterial infection in children worldwide, leading to excessive antibiotic consumption in children in most countries and to a substantial burden of deafness and suppurative complications in developing countries. The group attempted to move beyond the existing controversies surrounding guidelines on acute otitis media, and to propose to clinicians and public health officials their views on the actions needed to be taken to reduce the disease burden caused by acute otitis media and the microbial antibiotic resistance from the resulting use of antibiotics. Definition of acute otitis media and diagnostic accuracy are crucial steps to identify children who will potentially benefit from treatment with antibiotics and to eliminate unnecessary prescribing. Although the group agreed that antibiotics are distributed indiscriminately, even to children who do not seem to have the disease, no consensus could be reached on whether antibiotics should be given to all appropriately diagnosed children, reflecting the wide range of practices and lack of convincing evidence from observational studies. The major unanimous concern was an urgent need to reduce unnecessary prescribing of antibiotics to prevent further increases in antibiotic resistance. Prevention of acute otitis media with existing and future viral and bacterial vaccines seems the most promising approach to affect disease burden and consequences, both in developed and developing countries.
一个由多学科的中耳和儿科感染专家组成的国际小组开会探讨了在急性中耳炎管理方面存在共识的地方。在几位儿科传染病专家进行了非正式讨论之后，该小组扩大到包括更多具有中耳疾病专业知识的专业人员。急性中耳炎是全球儿童中非常常见的细菌感染，导致大多数国家的儿童过度使用抗生素，并在发展中国家造成大量耳聋和化脓性并发症。该小组试图超越急性中耳炎指南方面的现有争议，并向临床医生和公共卫生官员提出他们的观点，即需要采取行动来减轻急性中耳炎引起的疾病负担以及由此导致的抗生素耐药性。急性中耳炎的定义和诊断准确性是确定哪些儿童可能受益于抗生素治疗并消除不必要处方的关键步骤。尽管小组一致认为抗生素被滥用于治疗，甚至用于似乎没有患病的儿童，但对于是否应向所有经适当诊断的儿童给予抗生素，无法达成共识，这反映了广泛的实践和缺乏来自观察性研究的令人信服的证据。主要的一致关注是迫切需要减少不必要的抗生素处方，以防止抗生素耐药性进一步增加。使用现有的和未来的病毒和细菌疫苗预防急性中耳炎似乎是影响疾病负担和后果的最有前途的方法，无论是在发达国家还是发展中国家。
