Shaikh Nader, Dando Emily E, Dunleavy Mark L, Curran Dorothy L, Martin Judith M, Hoberman Alejandro, Smith Kenneth J
Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, Pittsburgh, PA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
J Pediatr. 2017 Oct;189:54-60.e3. doi: 10.1016/j.jpeds.2017.05.047. Epub 2017 Jun 28.
To assess whether antimicrobial therapy in young children with acute otitis media reduces time to resolution of symptoms, overall symptom burden, and persistence of otoscopic evidence of infection. We used a cost-utility model to evaluate whether immediate antimicrobial treatment seems to be worthwhile, and if so, which antimicrobial agent is most cost effective.
We compared the cost per quality-adjusted life-day of 5 treatment regimens in children younger than 2 years of age with acute otitis media: immediate amoxicillin/clavulanate, immediate amoxicillin, immediate cefdinir, watchful waiting, and delayed prescription (DP) for antibiotic.
The 5 treatment regimens, listed in order from least effective to most effective were DP, watchful waiting, immediate cefdinir, immediate amoxicillin, and immediate amoxicillin/clavulanate. Listed in order from least costly to most costly, the regimens were DP, immediate amoxicillin, watchful waiting, immediate amoxicillin/clavulanate, and immediate cefdinir. The incremental cost-utility ratio of immediate amoxicillin compared with DP was $101.07 per quality-adjusted life-day gained. The incremental cost-utility ratio of immediate amoxicillin/clavulanate compared with amoxicillin was $2331.28 per quality-adjusted life-day gained.
In children younger than 2 years of age with acute otitis media and no recent antibiotic exposure, immediate amoxicillin seems to be the most cost-effective initial treatment.
评估急性中耳炎幼儿使用抗菌治疗是否能缩短症状缓解时间、减轻总体症状负担以及消除耳镜检查感染迹象的持续时间。我们使用成本效益模型来评估立即进行抗菌治疗是否值得，若值得，哪种抗菌药物最具成本效益。
我们比较了2岁以下急性中耳炎患儿5种治疗方案每质量调整生命日的成本：立即使用阿莫西林/克拉维酸、立即使用阿莫西林、立即使用头孢地尼、观察等待以及抗生素延迟处方（DP）。
5种治疗方案按有效性从低到高依次为DP、观察等待、立即使用头孢地尼、立即使用阿莫西林、立即使用阿莫西林/克拉维酸。按成本从低到高依次为DP、立即使用阿莫西林、观察等待、立即使用阿莫西林/克拉维酸、立即使用头孢地尼。立即使用阿莫西林与DP相比，每获得一个质量调整生命日的增量成本效益比为101.07美元。立即使用阿莫西林/克拉维酸与阿莫西林相比，每获得一个质量调整生命日的增量成本效益比为2331.28美元。
对于2岁以下近期未使用过抗生素的急性中耳炎患儿，立即使用阿莫西林似乎是最具成本效益的初始治疗方法。
