a Anna Meyer Children׳s University Hospital, Department of Health Sciences, Section of Paediatrics , University of Florence , Florence , Italy.
b Primary care pediatrician , Venice , Italy.
Expert Rev Anti Infect Ther. 2017 Oct;15(10):897-902. doi: 10.1080/14787210.2017.1380518. Epub 2017 Sep 19.
With the aim to reduce inappropriate procedures and antibiotic therapy in the management of acute otitis media (AOM) in children, the Italian Society of Preventive and Social Pediatrics (SIPPS) proposed a top five list of recommendations for clinical practice. Areas covered: AOM is one of the most frequent reasons for antibiotic prescription in pediatric age. The over-estimation of AOM is associated with inappropriate treatment, increased costs, adverse events and spread of antibiotic resistance. Thus, the most recent guidelines provided stringent diagnostic criteria and considered the 'watchful waiting' approach, limiting the immediate antibiotic therapy to a well-characterized subgroup of children. Expert commentary: The five recommendations proposed are: 1) Do not diagnose AOM without having documented the presence of middle ear effusion 2) Do not diagnose AOM without examining the entire tympanic membrane; 3) Do not treat immediately all cases of AOM with antibiotics; 4) Do not administer ear analgesic drops until examining the whole tympanic membrane 5) Do not use macrolides in the AOM therapy. This list of top five recommendations could be a novel tool to spread the key messages on the guidelines and to promote the correct diagnostic procedures as well as a rational use of antibiotics in children.
为了减少儿童急性中耳炎（AOM）管理中不适当的程序和抗生素治疗，意大利预防和社会儿科学会（SIPPS）提出了临床实践的五项建议。涵盖领域：AOM 是儿科抗生素处方最常见的原因之一。AOM 的过度估计与不适当的治疗、增加的成本、不良事件和抗生素耐药性的传播有关。因此，最近的指南提供了严格的诊断标准，并考虑了“观察等待”方法，将立即使用抗生素治疗限制在具有明确特征的儿童亚组。专家评论：提出的五项建议是：1）没有记录中耳积液，不要诊断 AOM；2）没有检查整个鼓膜，不要诊断 AOM；3）不要立即用抗生素治疗所有 AOM 病例；4）在检查整个鼓膜之前，不要使用耳部镇痛滴剂；5）不要在 AOM 治疗中使用大环内酯类药物。这五项建议清单可以成为传播指南关键信息的新工具，并促进正确的诊断程序以及儿童抗生素的合理使用。
