Chee Jeremy, Pang Khang Wen, Yong Jui May, Ho Roger Chun-Man, Ngo Raymond
National University Health System, Singapore.
National University Health System, Singapore.
Int J Pediatr Otorhinolaryngol. 2016 Jul;86:183-8. doi: 10.1016/j.ijporl.2016.05.008. Epub 2016 May 11.
Antibiotic treatment is the standard of care for tympanostomy tube otorrhea. This meta-analysis aims to evaluate the efficacy of topical antibiotics with or without corticosteroids versus oral antibiotics in the treatment of tube otorrhea in children.
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and ProQuest.
The above databases were searched using a search strategy for randomized controlled trials for optimal treatment of tube otorrhea in the pediatric population. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. Primary outcome was cure (i.e. clearance of otorrhea) at 2-3 weeks. Secondary outcomes were microbiological eradication and complications such as dermatitis and diarrhea. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) and number needed to benefit (NNTB) in a random-effects model.
We identified 1491 articles and selected 4 randomized controlled trials which met our inclusion criteria. Topical treatment had better cure (NNTB = 4.7, pooled RR = 1.35, p < 0.001) and microbiological eradication (NNTB = 3.5, pooled RR = 1.47, p < 0.001 among 3 of the studies) than oral antibiotics. Oral antibiotics had higher risk of diarrhea (pooled RR = 21.5, 95% CI 8.00-58.0, p < 0.001, Number needed to harm (NNTH) = 5.4) and dermatitis (pooled RR = 3.14, 95% CI 1.20-8.20, p = 0.019, NNTH = 32). The use of topical steroids in addition to topical antibiotics was associated with a higher cure rate (pooled RR = 1.59, p < 0.001 vs pooled RR = 1.57, p = 0.293).
Topical antibiotics should be the recommended treatment for management of tympanostomy tube otorrhea in view of its significantly improved clinical and microbiological efficacy with lower risk of systemic toxicity as compared to oral antibiotics. Further research is necessary to confirm the benefits of topical corticosteroids as an adjunct to topical antibiotics.
抗生素治疗是鼓膜置管耳漏的标准治疗方法。本荟萃分析旨在评估局部使用抗生素（含或不含皮质类固醇）与口服抗生素治疗儿童鼓膜置管耳漏的疗效。
MEDLINE、EMBASE、Cochrane对照试验中央注册库和ProQuest。
使用针对儿科人群鼓膜置管耳漏最佳治疗的随机对照试验搜索策略对上述数据库进行检索。遵循PRISMA（系统评价和荟萃分析的首选报告项目）指南。主要结局是2至3周时的治愈（即耳漏清除）。次要结局是微生物清除以及皮炎和腹泻等并发症。这些事件的发生率定义为二分变量，并在随机效应模型中表示为风险比（RR）和需治疗获益人数（NNTB）。
我们识别出1491篇文章，并选择了4项符合纳入标准的随机对照试验。与口服抗生素相比，局部治疗具有更好的治愈率（NNTB = 4.7，合并RR = 1.35，p < 0.001）和微生物清除率（3项研究中NNTB = 3.5，合并RR = 1.47，p < 0.001）。口服抗生素导致腹泻的风险更高（合并RR = 21.5，95% CI 8.00 - 58.0，p < 0.001，需治疗伤害人数（NNTH） = 5.4）和皮炎（合并RR = 3.14，95% CI 1.20 - 8.20，p = 0.019，NNTH = 32）。局部使用抗生素的同时加用局部皮质类固醇与更高的治愈率相关（合并RR = 1.59，p < 0.001 对比 合并RR = 1.57，p = 0.293）。
鉴于与口服抗生素相比，局部使用抗生素具有显著改善的临床和微生物学疗效且全身毒性风险更低，应推荐将其作为鼓膜置管耳漏的治疗方法。有必要进一步研究以证实局部皮质类固醇作为局部抗生素辅助用药的益处。
