Hueston W J, Ornstein S, Jenkins R G, Pan Q, Wulfman J S
Department of Family Medicine, Medical University of South Carolina, Charleston 29425-0100, USA.
J Fam Pract. 1999 Jan;48(1):43-6.
Recurrent infection after an episode of otitis media is common in pediatric patients. If a patient experienced primary treatment failure in a preceding episode, physicians often feel pressured to prescribe a broad-spectrum, second-line agent for the next episode rather than a first-line drug. The purpose of our study was to determine whether using a second-line drug resulted in fewer treatment failures in a recurrent otitis episode following an episode of apparent resistance.
The Practice Partner Research Network database, a national research network of practices that use the same electronic medical record, was reviewed to identify all primary episodes of otitis media over a 2-year period (N = 7807). From this, 1416 pediatric patients with presumed treatment failures were identified. The subset of those with a second otitis media episode more than 90 days after the index episode (N = 343) was selected for study. Of this group, 236 (69%) received first-line antibiotics (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) and the remaining 107 received a broader-spectrum, second-line antibiotic. The primary outcome was the need for an additional antibiotic for otitis media within the next 45 days.
Patients receiving first- and second-line antibiotics did not differ in sex or age. However, those receiving second-line antibiotics had a shorter duration between episodes (231 vs 280 days, P = .007). Failure rates for first- and second-line antibiotics in recurrent episodes were not significantly different (13% vs 19%, P = .20). Because the duration between episodes could have affected failure rates, we stratified the time between episodes into short, intermediate, and long duration. Second-line antibiotics were not superior to first-line drugs in any stratum.
For a new otitis media episode in a patient with a previous treatment failure, first-line drugs (amoxicillin, ampicillin, penicillin, or sulfamethoxazole-trimethoprim) are just as effective as broader-spectrum, more expensive, second-line antibiotics.
中耳炎发作后反复感染在儿科患者中很常见。如果患者在前一次发作中经历了初始治疗失败，医生往往会感到有压力为下一次发作开具广谱二线药物而非一线药物。我们研究的目的是确定使用二线药物是否会减少在一次明显耐药发作后的复发性中耳炎发作中的治疗失败情况。
对实践伙伴研究网络数据库进行了审查，该数据库是一个使用相同电子病历的全国性实践研究网络，以识别两年期间所有中耳炎的初始发作（N = 7807）。从中确定了1416例疑似治疗失败的儿科患者。选择在索引发作后90天以上出现第二次中耳炎发作的子集（N = 343）进行研究。在该组中，236例（69%）接受一线抗生素（阿莫西林、氨苄西林、青霉素或磺胺甲恶唑 - 甲氧苄啶），其余107例接受更广谱的二线抗生素。主要结局是在接下来45天内是否需要额外使用抗生素治疗中耳炎。
接受一线和二线抗生素治疗的患者在性别或年龄上没有差异。然而，接受二线抗生素治疗的患者两次发作之间的间隔时间较短（231天对280天，P = 0.007）。复发性发作中一线和二线抗生素的失败率没有显著差异（13%对19%，P = 0.20）。由于两次发作之间的间隔时间可能影响失败率，我们将两次发作之间的时间分为短、中、长三个时间段。在任何一个时间段内，二线抗生素都不优于一线药物。
对于先前治疗失败的患者出现的新的中耳炎发作，一线药物（阿莫西林、氨苄西林、青霉素或磺胺甲恶唑 - 甲氧苄啶）与更广谱、更昂贵的二线抗生素效果相同。
