Department of Primary Care and Social Medicine, Imperial College London, London, UK.
Curr Opin Infect Dis. 2010 Jun;23(3):242-8. doi: 10.1097/QCO.0b013e328338c46d.
Most childhood respiratory infections including acute otitis media (AOM), sore throat, upper respiratory tract infections (URTIs) and sinusitis are self-limiting illnesses. Yet, despite extensive guidance discouraging routine use of antibiotics to limit side-effects and combat antimicrobial resistance, antibiotic prescribing for these conditions remains high in many developed countries, fuelled by the fear of rare but serious bacterial complications including mastoiditis, quinsy, pneumonia and brain abscess. This review summarizes evidence for the role of antibiotics in preventing serious complications of URTIs in children.
From a key observational study reporting antibiotic use in children, the calculated excess risk of suppurative complications of respiratory tract infections in children who did not receive an antibiotic was 3.8 per 10 000. Despite extensive searches of the literature, no data were found to assess the affect of antibiotics upon the risk of brain abscess after sinusitis in children.
New information from observational studies suggests antibiotics show little benefit in preventing complications of mastoiditis following AOM, quinsy following sore throat and pneumonia following URTI/bronchitis. Further research should focus on stratifying the key risk factors for such complications and optimizing long-term monitoring strategies to detect any future changes in the risk-benefit analysis for antibiotic prescription.
综述目的：大多数儿童呼吸道感染，包括急性中耳炎（AOM）、咽痛、上呼吸道感染（URTI）和鼻窦炎，都是自限性疾病。然而，尽管有广泛的指南不鼓励常规使用抗生素来限制副作用和对抗抗生素耐药性，但在许多发达国家，由于担心罕见但严重的细菌并发症，如乳突炎、扁桃体周围脓肿、肺炎和脑脓肿，这些疾病的抗生素处方仍然很高。本综述总结了抗生素在预防儿童 URTI 严重并发症方面的作用的证据。
最新发现：一项关键性观察性研究报告了儿童中抗生素的使用情况，计算出未接受抗生素治疗的儿童发生呼吸道感染化脓性并发症的超额风险为每 10000 人 3.8 人。尽管广泛搜索了文献，但没有数据评估抗生素对儿童鼻窦炎后脑脓肿风险的影响。
总结：来自观察性研究的新信息表明，抗生素在预防 AOM 后乳突炎、咽痛后扁桃体周围脓肿和 URTI/支气管炎后肺炎等并发症方面几乎没有益处。进一步的研究应集中在对这些并发症的关键风险因素进行分层，并优化长期监测策略，以检测抗生素处方的风险-效益分析的任何未来变化。
