Blumer J L
Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Childrens Hospital of University Hospitals of Cleveland, OH 44106, USA.
Pediatr Infect Dis J. 1998 Nov;17(11):1070-5; discussion 1099-100. doi: 10.1097/00006454-199811000-00037.
Selection of appropriate antibiotic treatment for children with acute otitis media (AOM) is challenging. Although the diagnosis is relatively easy for experienced clinicians, the distinction between AOM and otitis media with effusion is often more subtle. In general therapy is empiric and the pathogen causing disease in a given patient remains unknown. However, this situation is made even more difficult by the dynamic nature of the pathogenesis of AOM. Both the proportion of patients infected with one of the three primary pathogens, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, and the antimicrobial susceptibility patterns of these pathogens are changing. Currently there are 16 antibiotics labeled for use in AOM. Only 2 are reliably effective against penicillin-resistant pneumococcus: high dose amoxicillin (80 to 100 mg/kg/day) and im ceftriaxone. Among the others all are beta-lactamase-stable and have proven clinical effectiveness in AOM patients infected with H. influenzae or M. catarrhalis. Even with the high spontaneous resolution rate reported for AOM, antimicrobial therapy remains the standard of care in the United States. Recognition of the fundamental determinants of effective therapy should permit rational antibiotic selection for each patient.
为患有急性中耳炎（AOM）的儿童选择合适的抗生素治疗具有挑战性。尽管对于经验丰富的临床医生来说诊断相对容易，但AOM与中耳积液之间的区别往往更为细微。一般来说，治疗是经验性的，特定患者中引起疾病的病原体仍然未知。然而，AOM发病机制的动态性质使这种情况变得更加困难。感染三种主要病原体之一（肺炎链球菌、流感嗜血杆菌和卡他莫拉菌）的患者比例以及这些病原体的抗菌药敏模式都在变化。目前有16种抗生素被标记用于AOM。只有2种对耐青霉素肺炎球菌可靠有效：高剂量阿莫西林（80至100mg/kg/天）和头孢曲松。在其他抗生素中，所有都是β-内酰胺酶稳定的，并且已在感染流感嗜血杆菌或卡他莫拉菌的AOM患者中证明具有临床疗效。即使报道AOM有较高的自发缓解率，抗菌治疗在美国仍然是标准治疗方法。认识有效治疗的基本决定因素应该能够为每个患者合理选择抗生素。
