Shekelle Paul G, Takata Glenn, Newberry Sydne J, Coker Tumaini, Limbos Mary Ann, Chan Linda S, Timmer Martha M, Suttorp Marika J, Carter Jason, Motala Aneesa, Valentine Di, Johnsen Breanne, Shanman Roberta
Evid Rep Technol Assess (Full Rep). 2010 Nov(198):1-426.
Acute Otitis Media (AOM), a viral or bacterial infection of the ear, is the most common childhood infection for which antibiotics are prescribed in the United States. In 2001, the Southern California Evidence-based Practice Center conducted a systematic review of the evidence comparing treatments of AOM.
This review updates the 2001 review findings on diagnosis and treatment of uncomplicated AOM, assesses the evidence for treatment of recurrent AOM, and assesses the impact of the heptavalent pneumococcal conjugate (PCV7) vaccine on the microbiology of AOM.
Searches of PubMed® and the Cochrane databases were conducted from January 1998 to July 2010 using the same search strategies used for the 2001 report, with the addition of terms not considered in the 2001 review. The Web of Science was also searched for citations of the 2001 report and its peer-reviewed publications.
After review by two investigators against pre-determined inclusion/exclusion criteria, we included existing systematic reviews and randomized controlled clinical trials for assessment of treatment efficacy and safety. Pooled analysis was performed for comparisons with three or more trials.
Few studies were found that examined the accuracy and precision of the diagnosis of AOM. Since PCV7's introduction, AOM microbiology has shifted significantly, with Streptococcus pneumoniae becoming less prevalent and Haemophilus influenzae (HF) increasing in importance. For uncomplicated AOM, pooled analysis indicates that nine children (95% CI: 6, 20) would need to be treated with ampicillin or amoxicillin rather than placebo to note a difference in the rate of clinical success. However, in four studies of delayed treatment approaches for uncomplicated AOM, two had higher rates of clinical success with immediate antibiotic therapy while two did not, and in three studies, a marked decrease in antibiotic utilization was noted. We are unable to draw definitive conclusions regarding the comparative effectiveness of different antibiotics for AOM in children with recurrent otitis media (ROM). For ROM, long-term antibiotic administration will decrease AOM episodes from 3 to 1.5 for every 12 months of treatment per otitis prone child during active treatment (95% CI: 1.2, 2.1); however, potential consequences of long-term treatment need to be considered. Data were insufficient to draw conclusions about comparative effectiveness of different treatment strategies in subgroups of children with uncomplicated AOM. Adverse events were generally more frequent for amoxicillin-clavulanate than for cefdinir, ceftriaxone, or azithromycin. Higher quality studies and improved reporting of study characteristics related to quality are needed to provide definitive conclusions for AOM and ROM treatment options.
急性中耳炎（AOM）是一种耳部的病毒或细菌感染，是美国最常见的儿科感染疾病，针对该疾病美国会开具抗生素处方。2001年，南加州循证实践中心对比较AOM治疗方法的证据进行了系统评价。
本评价更新了2001年关于单纯性AOM诊断和治疗的评价结果，评估复发性AOM治疗的证据，并评估七价肺炎球菌结合疫苗（PCV7）对AOM微生物学的影响。
1998年1月至2010年7月期间，使用与2001年报告相同的检索策略对PubMed®和Cochrane数据库进行检索，并增加了2001年评价中未考虑的检索词。还在科学网中检索了2001年报告及其同行评审出版物的引用文献。
由两名研究人员根据预先确定的纳入/排除标准进行评审后，我们纳入了现有的系统评价和随机对照临床试验，以评估治疗效果和安全性。对三项或更多试验的比较进行了汇总分析。
很少有研究考察AOM诊断的准确性和精确性。自引入PCV7以来，AOM的微生物学发生了显著变化，肺炎链球菌的流行率降低，而流感嗜血杆菌（HF）的重要性增加。对于单纯性AOM，汇总分析表明，需要用氨苄西林或阿莫西林而非安慰剂治疗9名儿童（95%CI：6，20）才能注意到临床成功率的差异。然而，在四项关于单纯性AOM延迟治疗方法的研究中，两项研究中立即使用抗生素治疗的临床成功率较高，而两项则不然，并且在三项研究中，抗生素使用量显著减少。对于复发性中耳炎（ROM）患儿，我们无法就不同抗生素对AOM的比较有效性得出明确结论。对于ROM，在积极治疗期间，每例易患中耳炎的儿童每接受12个月的治疗，长期使用抗生素将使AOM发作次数从3次降至1.5次（95%CI：1.2，2.1）；然而，需要考虑长期治疗的潜在后果。数据不足以就不同治疗策略在单纯性AOM患儿亚组中的比较有效性得出结论。阿莫西林-克拉维酸的不良事件通常比头孢地尼、头孢曲松或阿奇霉素更频繁。需要更高质量的研究和改进与质量相关的研究特征报告，以便为AOM和ROM的治疗选择提供明确结论。
