Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester NY 14621, USA.
Pediatr Infect Dis J. 2013 May;32(5):473-8. doi: 10.1097/INF.0b013e3182862b57.
We sought to determine if use of more stringent diagnostic criteria for acute otitis media (AOM) than currently advocated by the American Academy of Pediatrics, tympanocentesis and pathogen-specific antibiotic treatment (individualized care) would result in reducing the incidence of recurrent AOM and consequent tympanostomy tube surgery.
A 5-year longitudinal, prospective study in Rochester, NY, was conducted from July 2006 to July 2011 involving 254 individualized care children. When this individualized care group developed symptoms of AOM, strict diagnostic criteria were applied and a tympanocentesis was performed. Pathogen resistance to empiric high-dose amoxicillin/clavulanate (80 mg/kg of amoxicillin component) caused a change in antibiotic to an optimized choice. Legacy controls (n = 208) were diagnosed with the same diagnostic criteria by the same physicians as the individualized care group and received the same empiric amoxicillin/clavulanate (80 mg/kg of amoxicillin component) but no tympanocentesis or change in antibiotic. Community control children (n = 1020) were diagnosed according to current American Academy of Pediatrics guidelines and treated with high-dose amoxicillin (80 mg/kg) without tympanocentesis as guideline recommended.
5.9% of children of the individualized care group compared with 14.4% of Legacy controls and 27.3% of community controls became otitis prone, defined as 3 episodes of AOM within a 6-month time span or 4 AOM episodes within a 12-month time span (P < 0.0001). 2.4% of the individualized care group compared with 6.3% of Legacy controls, and 14.8% of community controls received tympanostomy tubes (P < 0.0001).
Individualized care of AOM significantly reduces the frequency of AOM and tympanostomy tube surgery. Use of strict diagnostic criteria for AOM and empiric antibiotic treatment using evidence-based knowledge of circulating otopathogens and their antimicrobial susceptibility profile also produces improved outcomes.
我们旨在确定与美国儿科学会目前提倡的急性中耳炎（AOM）诊断标准相比，使用更严格的诊断标准（经鼓膜穿刺术和针对病原体的抗生素治疗[个体化治疗]）是否会降低复发性 AOM 和随后鼓膜置管手术的发生率。
2006 年 7 月至 2011 年 7 月，在纽约罗彻斯特进行了一项为期 5 年的纵向前瞻性研究，涉及 254 名接受个体化治疗的儿童。当该个体化治疗组出现 AOM 症状时，采用严格的诊断标准并进行鼓膜穿刺术。经验性使用高剂量阿莫西林/克拉维酸（阿莫西林成分 80mg/kg）治疗后病原体产生耐药性时，抗生素会更改为优化选择。传统对照组（n=208）由与个体化治疗组相同的医生根据相同的诊断标准诊断，并接受相同的经验性阿莫西林/克拉维酸（阿莫西林成分 80mg/kg）治疗，但不进行鼓膜穿刺术或抗生素更换。社区对照组儿童（n=1020）根据当前美国儿科学会指南诊断，并按照指南建议使用高剂量阿莫西林（80mg/kg）治疗，无需鼓膜穿刺术。
与传统对照组（14.4%）和社区对照组（27.3%）相比，个体化治疗组的 5.9%儿童变得易患中耳炎，定义为 6 个月内发作 3 次 AOM 或 12 个月内发作 4 次 AOM（P<0.0001）。与传统对照组（6.3%）和社区对照组（14.8%）相比，个体化治疗组的 2.4%儿童接受了鼓膜置管（P<0.0001）。
AOM 的个体化治疗可显著降低 AOM 和鼓膜置管手术的频率。使用严格的 AOM 诊断标准和根据循环性耳病原体及其抗菌药物敏感性特征的循证知识进行经验性抗生素治疗也可改善治疗效果。
