Davies Timothy, Peng Xicheng, Salem Joseph, Elcioglu Zeynep C, Kremneva Anna, Gruber Mei-Yin, Milinis Kristijonas, Mather Michael W, Powell Jason, Sharma Sunil
Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK.
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
Clin Otolaryngol. 2025 Jan;50(1):1-14. doi: 10.1111/coa.14240. Epub 2024 Oct 12.
Acute otitis media (AOM) is a common childhood infection. Recurrent AOM affects a subset of children, resulting in an adverse impact on quality of life, socioeconomic disadvantage, and risk of long-term sequelae. Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long-term effects and contribution to global antibiotic resistance.
A comprehensive literature search was undertaken using Medline (1946-October 2023) and Embase (1974-October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children < 18 years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta-analysis was carried out using random-effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the I statistic.
The effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes.
assessment of antimicrobial agents and outcomes in children with risk factors.
Assessment of qualitative data was performed on 20 studies (n = 2210). No controlled trials were identified post-multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. Quantitative meta-analysis on nine pre-PCV studies (n = 1087) demonstrated antimicrobial chemoprophylaxis reduced any episode of AOM with a risk ratio 0.59 (95% CI 0.45-0.77).
Families and clinicians must balance marginal short-medium term benefit (based on pre-PCV data), and the potential for adverse effects to that individual, and the societal risk of antimicrobial resistance with prolonged antibiotic use.
急性中耳炎（AOM）是一种常见的儿童感染性疾病。复发性急性中耳炎影响一部分儿童，对生活质量、社会经济状况产生不利影响，并存在长期后遗症风险。在某些情况下会使用抗菌药物预防性治疗，但由于意识到其长期不良影响以及对全球抗生素耐药性的影响，这种治疗方法越来越具有争议性。
使用Medline（1946年 - 2023年10月）和Embase（1974年 - 2023年10月）进行了全面的文献检索。主要目的是评估抗菌药物预防性治疗对18岁以下儿童AOM发作次数的疗效。进行了偏倚和质量评估。使用风险比及95%置信区间对二分数据进行分析。采用随机效应模型进行荟萃分析以进行汇总分析，不受异质性影响。使用I²统计量评估异质性。
抗菌药物预防性治疗对复发性急性中耳炎儿童个体AOM发作次数的影响。
对有危险因素儿童的抗菌药物及治疗结果进行评估。
对20项研究（n = 2210）进行了定性数据评估。在引入多价肺炎球菌结合疫苗（PCV）后未发现对照试验，限制了当前的普遍性。对9项PCV引入前的研究（n = 1087）进行的定量荟萃分析表明，抗菌药物预防性治疗可降低AOM发作次数，风险比为0.59（95%CI 0.45 - 0.77）。
家庭和临床医生必须权衡（基于PCV引入前数据的）短期至中期的边际益处、对个体的潜在不良影响以及长期使用抗生素导致的抗菌药物耐药性的社会风险。
