Steele Dale W, Adam Gaelen P, Di Mengyang, Halladay Christopher W, Balk Ethan M, Trikalinos Thomas A
Evidence-Based Practice Center, Center for Evidence Synthesis in Health, and
Departments of Health Services, Policy and Practice, School of Public Health.
Pediatrics. 2017 Jun;139(6). doi: 10.1542/peds.2017-0667. Epub 2017 May 5.
Children with tympanostomy tubes often develop ear discharge.
Synthesize evidence about the need for water precautions (ear plugs or swimming avoidance) and effectiveness of topical versus oral antibiotic treatment of otorrhea in children with tympanostomy tubes.
Searches in Medline, the Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews, Excerpta Medica Database, and the Cumulative Index to Nursing and Allied Health Literature.
Abstracts and full-text articles independently screened by 2 investigators.
25 articles were included.
One randomized controlled trial (RCT) in children assigned to use ear plugs versus no precautions reported an odds ratio (OR) of 0.68 (95% confidence interval, 0.37-1.25) for >1 episode of otorrhea. Another RCT reported an OR of 0.71 (95% confidence interval, 0.29-1.76) for nonswimmers versus swimmers. Network meta-analyses suggest that, relative to oral antibiotics, topical antibiotic-glucocorticoid drops were more effective: OR 5.3 (95% credible interval, 1.2-27). The OR for antibiotic-only drops was 3.3 (95% credible interval, 0.74-16). Overall, the topical antibiotic-glucocorticoid and antibiotic-only preparations have the highest probabilities, 0.77 and 0.22 respectively, of being the most effective therapies.
Sparse randomized evidence (2 RCTs) and high risk of bias for nonrandomized comparative studies evaluating water precautions. Otorrhea treatments include non-US Food and Drug Administration approved, off-label, and potentially ototoxic antibiotics.
No compelling evidence of a need for water precautions exists. Cure rates are higher for topical drops than oral antibiotics.
佩戴鼓膜置管的儿童常出现耳部流脓。
综合关于鼓膜置管儿童耳部防水措施（耳塞或避免游泳）的必要性以及局部与口服抗生素治疗耳部流脓有效性的证据。
检索Medline、Cochrane中央试验注册库、Cochrane系统评价数据库、医学文摘数据库以及护理与健康相关文献累积索引。
由2名研究者独立筛选摘要和全文文章。
纳入25篇文章。
一项针对儿童使用耳塞与无防护措施的随机对照试验（RCT）报告，耳部流脓发作>1次的比值比（OR）为0.68（95%置信区间，0.37 - 1.25）。另一项RCT报告，非游泳者与游泳者的OR为0.71（95%置信区间，0.29 - 1.76）。网状Meta分析表明，相对于口服抗生素，局部用抗生素 - 糖皮质激素滴剂更有效：OR为5.3（95%可信区间，1.2 - 27）。仅用抗生素滴剂的OR为3.3（95%可信区间，0.74 - 16）。总体而言，局部用抗生素 - 糖皮质激素制剂和仅用抗生素制剂分别以0.77和0.22的最高概率成为最有效的治疗方法。
随机证据稀少（2项RCT），且评估防水措施的非随机对照研究存在高偏倚风险。耳部流脓治疗包括未获美国食品药品监督管理局批准、标签外使用以及具有潜在耳毒性的抗生素。
不存在需要采取防水措施的令人信服的证据。局部滴剂的治愈率高于口服抗生素。
