Schoch Adriaan G, van Marwijk H W J Harm
VUmc, afd. Huisartsgeneeskunde, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(10):A4027.
Recently, two randomised, double-blind, placebo-controlled trials published in The New England Journal of Medicine have stirred up discussion about the use of antibiotics in the treatment of acute otitis media (AOM). In the Netherlands, the practice guideline of the Dutch College of General Practitioners recommends withholding antibiotics in most cases and that antibiotics can be considered when a child under the age of 2 years has bilateral AOM, otorrhoea, or persistent symptoms for 3 days or more. These recommendations are mostly based on a meta-analysis published in 2006. Previous studies on AOM had important limitations such as varying diagnostic criteria and biased patient selection. The new trials, which are of high methodological quality, investigated only 'real' AOM and the results show the same efficacy as the aforementioned meta-analysis. We therefore feel it is justified to consider prescribing antibiotics for a young child with manifest symptoms and evident AOM on otoscopic examination.
最近，发表在《新英格兰医学杂志》上的两项随机、双盲、安慰剂对照试验引发了关于抗生素在急性中耳炎（AOM）治疗中应用的讨论。在荷兰，荷兰全科医生学院的实践指南建议在大多数情况下不使用抗生素，而当2岁以下儿童患有双侧AOM、耳漏或持续症状达3天或更长时间时可考虑使用抗生素。这些建议大多基于2006年发表的一项荟萃分析。以往关于AOM的研究存在重要局限性，如诊断标准不同和患者选择有偏差。新的试验方法学质量很高，仅研究“真正的”AOM，结果显示与上述荟萃分析具有相同的疗效。因此，我们认为对于耳镜检查有明显症状和明确AOM的幼儿考虑使用抗生素是合理的。
