Sclafani A P, Ginsburg J, Shah M K, Dolitsky J N
Department of Otolaryngology-Head & Neck Surgery, New York Eye & Ear Infirmary, New York, New York 10003, USA.
Pediatrics. 1998 Apr;101(4 Pt 1):675-81. doi: 10.1542/peds.101.4.675.
To evaluate the short- and long-term effects of treatment of symptomatic chronic adenotonsillar hypertrophy (CATH) with a 30-day course of amoxicillin/clavulanate potassium (AMOX/CLAV).
Children 2 to 16 years of age with obstructive symptoms attributable to CATH, who did not have a history of recurrent adenotonsillitis.
A prospective, randomized, double-blinded, placebo-controlled trial.
Ambulatory clinic of a tertiary care hospital.
Patients were randomly treated with 30-day courses of either placebo (PLAC) or AMOX/CLAV (40 mg/kg in 3 divided doses daily).
Patients' signs and symptoms were assessed by physical examination and by both physician and parental forced-choice questionnaires 1, 3, and 24 months after treatment. The decision to proceed to surgery or to continue expectant management was made for all patients by the same physician, based on reported symptoms and physical findings.
Treatment with a 30-day course of AMOX/CLAV significantly reduced the need for surgery in the short term compared with PLAC (37.5% vs 62.7%) at 1-month follow-up). The reduced need for surgery in the AMOX/CLAV-treated group persisted at 3 months (AMOX/CLAV 54.5% vs PLAC 85.7%) and 24 months (AMOX/CLAV 83.3% vs PLAC 98.0%).
A 30-day course of AMOX/CLAV significantly reduces the need for surgery in children with obstructive adenotonsillar hypertrophy at 1-month follow-up. This relative reduction persists at 3 and 24 months posttreatment, although the absolute percentages of patients requiring surgery increased in both groups as time after treatment increased. The reduction in symptoms in AMOX/CLAV-treated patients is modest but significant even in long-term follow-up. The precise role of this treatment for CATH is yet to be determined; however, our results suggest that a 30-day course of AMOX/CLAV can be used in situations when a temporary relief in symptoms is desirable or surgery would incur unacceptable risk.
评估采用30天疗程的阿莫西林/克拉维酸钾（AMOX/CLAV）治疗有症状的慢性腺样体扁桃体肥大（CATH）的短期和长期效果。
2至16岁因CATH出现阻塞性症状且无复发性腺扁桃体炎病史的儿童。
一项前瞻性、随机、双盲、安慰剂对照试验。
一家三级护理医院的门诊诊所。
患者被随机给予30天疗程的安慰剂（PLAC）或AMOX/CLAV（每日40mg/kg，分3次服用）进行治疗。
在治疗后1个月、3个月和24个月，通过体格检查以及医生和家长的强制选择问卷对患者的体征和症状进行评估。由同一位医生根据报告的症状和体格检查结果，为所有患者做出进行手术或继续观察治疗的决定。
在1个月随访时，与PLAC相比，30天疗程的AMOX/CLAV治疗显著降低了短期内的手术需求（37.5%对62.7%）。AMOX/CLAV治疗组手术需求的降低在3个月（AMOX/CLAV 54.5%对PLAC 85.7%）和24个月（AMOX/CLAV 83.3%对PLAC 98.0%）时仍然存在。
30天疗程的AMOX/CLAV在1个月随访时显著降低了阻塞性腺样体扁桃体肥大儿童的手术需求。尽管随着治疗后时间的增加，两组中需要手术的患者绝对百分比都有所增加，但这种相对降低在治疗后3个月和24个月时仍然存在。即使在长期随访中，接受AMOX/CLAV治疗的患者症状减轻幅度不大但具有显著意义。这种治疗方法对CATH的确切作用尚待确定；然而，我们的结果表明，当希望暂时缓解症状或手术会带来不可接受的风险时，30天疗程的AMOX/CLAV可用于此类情况。
