Pediatric Research in Emergency Therapeutics (PRETx) program, BC Children's Hospital, Vancouver, BC.
Can Fam Physician. 2011 Nov;57(11):1283-5.
As concern about antimicrobial resistance grows, I am aware of the need to reduce unnecessary antibiotic treatment; however, in my practice I see many children with acute otitis media (AOM) and this is the most common reason I prescribe antibiotics. Most of these children are young and otherwise healthy, and I am uncertain about when to prescribe antibiotics and when to endorse "watchful waiting." Which children will benefit from antibiotic treatment?
Current Canadian guidelines recommend all children younger than 2 years of age with otalgia due to AOM and fever greater than 39°C be considered for treatment with amoxicillin. Watchful waiting is indicated only for children older than 6 months with mild-to-moderate AOM. Recent evidence suggests young children with a definitive diagnosis of AOM will benefit from antibiotics and experience fewer treatment failures compared with placebo, regardless of the severity of otitis. These studies do not challenge watchful waiting directly, and determining which children will improve spontaneously remains an enigma.
随着对抗生素耐药性的担忧日益增加，我意识到有必要减少不必要的抗生素治疗；然而，在我的实践中，我看到许多患有急性中耳炎（AOM）的儿童，这也是我开抗生素的最常见原因。这些孩子大多年龄较小，身体健康，但我不确定何时开抗生素，何时支持“静观其变”。哪些儿童将从抗生素治疗中受益？
目前加拿大的指南建议，所有因 AOM 而出现耳痛且体温高于 39°C 的 2 岁以下儿童，均应考虑用阿莫西林治疗。只有对症状较轻至中度的 AOM 患儿，6 个月以上的儿童才需要静观其变。最近的证据表明，与安慰剂相比，明确诊断为 AOM 的幼儿使用抗生素治疗将获益更多，并且治疗失败的风险更低，无论中耳炎的严重程度如何。这些研究并没有直接质疑静观其变，确定哪些儿童会自行改善仍然是个谜。
