Perriello V A, Ford R F, McLean W C, Schoeny Z G, Sande M A
Va Med. 1977 May;104(5):319-20, 325-8.
We have presented recommendations for diagnosis and management of otitis media in children based on a comprehensive review of the pertinent medical literature. For an entity that is so common, there still remain amazingly large numbers of areas of controversy. We have also attempted to stress the importance of appropriate therapy and adequate followup as being very important in the management of otitis media. Newer concepts, particularly the use of the impedance bridge tympanogram, have been mentioned. With all the above background information in mind and with considerations for what is practical for the patient and the medical community, we would recommend the following as the acceptable minimal care for patients with otitis media. When the diagnosis of the acute otitis media is made on the basis of physical findings of myringitis, and/or middle ear fluid, and/or rupture of the tympanic membrane, the following treatment course is advisable: Neonates Culture of middle ear fluid if possible. Ampicillin 200 mg/kg/day intramuscularly. Gentamicin 3/5mg/kg/day intramuscularly. Hospitalize and treat until well and for minimum of seven days. Observe closely for meningitis and other infections and drug toxicity. These should be handled only by physicians experienced in dealing with patients in this age range. Appropriate work-up for septicemia should precede treatment. Switch to specific antibiotic when cultures and sensitivity available. Children. From 2 months to 6 years of age: Ampicillin 50mg/kg/day. Decongestant (if desired). Administer for ten days. Every patient with otorrhea, severe otitis and those not clinically well should be seen for followup ten to 14 days later. They should have a minimum of otologic evaluation including drum mobility. In persistent cases, audiometry and otologic referral are necessary. If patient is allergic to penicillin, erythromycin at 20mg/lb/day may be used. Trimethoprim sulfa may hold promise in the future. Tetracycline is never indicated in this age range because of side effects and high relapse rate secondary to resistant organisms. Patients above 6 years of age: Penicillin pheyoxymethyl 250 mg every six hours for ten days. Decongestant (if desired). Followup and penicillin allergy as above.
我们基于对相关医学文献的全面综述，提出了儿童中耳炎诊断与治疗的建议。对于这样一种常见病症，仍存在大量惊人的争议领域。我们还试图强调适当治疗和充分随访在中耳炎管理中的重要性。文中提到了一些较新的概念，特别是阻抗桥鼓室图的应用。考虑到上述所有背景信息，并兼顾对患者和医疗界切实可行的因素，我们建议以下内容作为中耳炎患者可接受的最低限度治疗方案。当根据鼓膜炎症、和/或中耳积液、和/或鼓膜穿孔的体格检查结果诊断为急性中耳炎时，建议采用以下治疗方案：新生儿尽可能进行中耳积液培养。氨苄西林200mg/kg/天，肌内注射。庆大霉素3/5mg/kg/天，肌内注射。住院治疗直至痊愈，至少治疗七天。密切观察是否有脑膜炎及其他感染和药物毒性。这些情况应由有处理该年龄范围患者经验的医生处理。治疗前应进行败血症的适当检查。培养结果和药敏结果出来后改用特定抗生素。儿童2个月至6岁：氨苄西林50mg/kg/天。减充血剂（如有需要）。给药十天。每例有耳漏、严重中耳炎及临床症状未改善的患者应在10至14天后复诊。他们至少应进行耳科评估，包括鼓膜活动度检查。对于持续性病例，需要进行听力测定并转诊至耳科。如果患者对青霉素过敏，可使用红霉素20mg/磅/天。甲氧苄啶磺胺类药物未来可能有应用前景。由于副作用和耐药菌导致的高复发率，该年龄范围绝不能使用四环素。6岁以上患者：青霉素V钾250mg，每6小时一次，共十天。减充血剂（如有需要）。随访及青霉素过敏处理同上述儿童患者。
