Del Mar C, Glasziou P, Hayem M
Centre for General Practice, University of Queensland, Graduate School of Medicine, Brisbane, Australia.
BMJ. 1997 May 24;314(7093):1526-9. doi: 10.1136/bmj.314.7093.1526.
To determine the effect of antibiotic treatment for acute otitis media in children.
Systematic search of the medical literature to identify studies that used antibiotics in randomised controlled trials to treat acute otitis media. Studies were examined blind, and the results of those of satisfactory quality of methodology were pooled.
Six studies of children aged 7 months to 15 years.
Pain, deafness, and other symptoms related to acute otitis media or antibiotic treatment.
60% of placebo treated children were pain free within 24 hours of presentation, and antibiotics did not influence this. However, at 2-7 days after presentation, by which time only 14% of children in control groups still had pain, early use of antibiotics reduced the risk of pain by 41% (95% confidence interval 14% to 60%). Antibiotics reduced contralateral acute otitis media by 43% (9% to 64%). They seemed to have no influence on subsequent attacks of otitis media or deafness at one month, although there was a trend for improvement of deafness at three months. Antibiotics were associated with a near doubling of the risk of vomiting, diarrhoea, or rashes (odds ratio 1.97 (1.19 to 3.25)).
Early use of antibiotics provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2-7 days after presentation, 17 children must be treated with antibiotics early.
确定抗生素治疗对儿童急性中耳炎的效果。
系统检索医学文献，以找出在随机对照试验中使用抗生素治疗急性中耳炎的研究。对研究进行盲法审查，并汇总方法学质量令人满意的研究结果。
六项针对7个月至15岁儿童的研究。
疼痛、听力减退以及与急性中耳炎或抗生素治疗相关的其他症状。
60%接受安慰剂治疗的儿童在就诊后24小时内疼痛消失，抗生素对此并无影响。然而，在就诊后2至7天，此时对照组中只有14%的儿童仍有疼痛，早期使用抗生素可将疼痛风险降低41%（95%置信区间为14%至60%）。抗生素可使对侧急性中耳炎的发生率降低43%（9%至64%）。抗生素似乎对随后一个月的中耳炎发作或听力减退没有影响，不过在三个月时听力减退有改善的趋势。抗生素与呕吐、腹泻或皮疹风险几乎翻倍相关（比值比为1.97（1.19至3.25））。
早期使用抗生素对急性中耳炎仅提供适度益处：为防止一名儿童在就诊后2至7天仍有疼痛，必须对17名儿童早期使用抗生素进行治疗。
