Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO; Center for Health Systems Research, Denver Health and Hospital Authority, Denver, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
J Pediatr. 2022 Dec;251:98-104.e5. doi: 10.1016/j.jpeds.2022.07.053. Epub 2022 Aug 6.
The objective of the study was to compare the antibiotic treatment failure and recurrence rates between antibiotic agents (amoxicillin, amoxicillin-clavulanate, cefdinir, and azithromycin) for children with uncomplicated acute otitis media (AOM).
We completed a retrospective cohort study of children 6 months-12 years of age with uncomplicated AOM identified in a nationwide claims database. The primary exposure was the antibiotic agent, and the primary outcomes were treatment failure and recurrence. Logistic regression was used to estimate ORs, and analyses were stratified by primary exposure, patient age, and antibiotic duration.
Among the 1 051 007 children included in the analysis, 56.6% were prescribed amoxicillin, 13.5% were prescribed amoxicillin-clavulanate, 20.6% were prescribed cefdinir, and 9.3% were prescribed azithromycin. Most prescriptions (93%) were for 10 days, and 98% were filled within 1 day of the medical encounter. Treatment failure and recurrence occurred in 2.2% (95% CI: 2.1, 2.2) and 3.3% (3.2, 3.3) of children, respectively. Combined failure and recurrence rates were low for all agents including amoxicillin (1.7%; 1.7, 1.8), amoxicillin-clavulanate (11.3%; 11.1, 11.5), cefdinir (10.0%; 9.8, 10.1), and azithromycin (9.8%; 9.6, 10.0).
Despite microbiologic changes in AOM etiology, treatment failure and recurrence were uncommon for all antibiotic agents and were lower for amoxicillin than for other agents. These findings support the continued use of amoxicillin as a first-line agent for AOM when antibiotics are prescribed.
本研究旨在比较不同抗生素药物（阿莫西林、阿莫西林-克拉维酸、头孢地尼和阿奇霉素）治疗儿童单纯性急性中耳炎（AOM）的抗生素治疗失败率和复发率。
我们对全国性理赔数据库中诊断为单纯性 AOM 的 6 个月至 12 岁儿童进行了回顾性队列研究。主要暴露因素为抗生素药物，主要结局为治疗失败和复发。采用逻辑回归估计比值比（OR），并根据主要暴露因素、患者年龄和抗生素使用时间进行分层分析。
在纳入分析的 1051007 名儿童中，56.6%的患儿处方了阿莫西林，13.5%的患儿处方了阿莫西林-克拉维酸，20.6%的患儿处方了头孢地尼，9.3%的患儿处方了阿奇霉素。大多数处方（93%）为 10 天疗程，98%的处方在就诊当天完成配药。治疗失败和复发的发生率分别为 2.2%（95%CI：2.1，2.2）和 3.3%（3.2，3.3）。所有药物的联合失败和复发率均较低，包括阿莫西林（1.7%；1.7，1.8）、阿莫西林-克拉维酸（11.3%；11.1，11.5）、头孢地尼（10.0%；9.8，10.1）和阿奇霉素（9.8%；9.6，10.0）。
尽管 AOM 病因的微生物学发生了变化，但所有抗生素药物的治疗失败和复发均不常见，且阿莫西林的失败率低于其他药物。这些发现支持在开具抗生素时继续将阿莫西林作为 AOM 的一线药物。
