噴出による中耳炎 ("分泌性"中耳炎) に対する抗菌療法
E I Cantekin1, T W McGuire, T L Griffith
1Department of Otolaryngology, University of Pittsburgh, PA.
JAMA
|December 18, 1991
まとめ
アモキシチリンを含む抗微生物治療は,子供の持続的な中耳出血の治療に効果的ではありません. この研究では,治療後の有意な効果とさらに高い再発率が見つかりませんでしたので,この状態に対する抗生物質の使用は疑問視されています.
科学分野:
- 小児 otorhinolaryngology (小児 otorhinolaryngology) とは,小児 otorhinolaryngology (小児 otorhinolaryngology) とは,小児 otorhinolaryngology (小児 otorhinolaryngology) とは,小児 otorhinolaryngology (小児 otorhinolaryngology) とは,小児 otorhinolaryngology (小児 otorhinolaryngology) とは,小児 otorhinolaryngology (小児 otorhinolaryngology) とは,小児 otorhinolaryngology (小児 otorhinolaryngology) とは,小児 otorhinolaryngology (小児 otorhinolaryngology) とは
- 根拠に基づいた医学は,証拠に基づいた医療です.
- 臨床試験分析 臨床試験分析について
背景:
- 噴出性中耳炎 (OME),また,分泌性中耳炎とも呼ばれる中耳炎は,小児における一般的な疾患です.
- 持続的な中耳漏れは,聴覚障害や言語の遅延につながる可能性があります.
- OMEに対する抗微生物治療の有効性は,依然として調査の対象となっている.
研究 の 目的:
- 小児における噴出性中耳炎に対する抗菌剤治療の有効性を再検討する.
- アモキシシリンの有効性を評価するために,OME.に対して,脱血剤と抗ヒスタミン剤の併用または併用なしに,
主な方法:
- OMEを患った518人の子どもを対象とした二重盲検,プラセボ対照,ランダム化試験の再分析.
- アモキシチリントリヒドレートの2週間のコースの評価, 4週間の解凍剤-抗ヒスタミンコースとまたはそれなし.
- ティッパノメトリー,聴覚改善対策,オトスコーピーの判断を用いた結果の評価.
主要な成果:
- アモキシシリンは4週間で音筒測定 (P = .121) と聴覚測定 (P = .311) によって無意味な有効性を示しました.
- オトスコーピーの判断は限界の有効性を示唆したが,この方法は体系的なバイアスを含むことが判明した.
- アモキシチリン治療を受けた小児の治療後の出血の再発率は2~6倍 (P=0.001) であった.
結論:
- アモキシシリンは,単独でも,脱血剤-抗ヒスタミンと併用しても,小児における持続的な無症状の中耳出血に対して効果的ではありません.
- この研究では,この文脈でのオトスコーピーの観察の妥当性について疑問を投げかけ,抗生物質療法による利益の欠如を強調しています.
- より高い再発率は,OMEに対するアモキシチリン治療による潜在的な害や解決の欠如を示唆しています.
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