中耳炎的抗菌疗法与输液 ("分泌"中耳炎)
E I Cantekin1, T W McGuire, T L Griffith
1Department of Otolaryngology, University of Pittsburgh, PA.
JAMA
|December 18, 1991
概括
包括阿莫西西林在内的抗微生物治疗对于治疗儿童持续的中耳液是无效的. 这项研究发现没有显著的益处,甚至在治疗后复发率更高,质疑对这种疾病的抗生素的使用.
科学领域:
- 儿科耳鼻喉科 儿科耳鼻喉科
- 基于证据的医学基于证据的医学.
- 临床试验分析
背景情况:
- 带出血的中耳炎 (OME),也称为分泌性中耳炎,是儿童常见的疾病.
- 持续的中耳溢出会导致听力障碍和言语迟缓.
- 对OME抗微生物治疗的有效性仍然是调查的主题.
研究的目的:
- 重新检查抗菌药物治疗儿童中耳炎与输液的有效性.
- 为了评估阿莫西西林的疗效,有或没有降血剂-抗胺组合,对OME.
主要方法:
- 重新分析了一项双盲,安慰剂控制,随机化试验,涉及518名患有OME的儿童.
- 评估2周的阿莫西西林三水合剂疗程,有或没有4周的消血剂-抗胺剂疗程.
- 通过耳计,听力改善措施和耳镜判断来评估结果.
主要成果:
- 在4周后,阿莫西西林通过耳 tympanometry (P = .121) 和听力测量 (P = .311) 显示出无意义的疗效.
- 耳视镜判断表明有效性有限,但这种方法被发现包含系统偏差.
- 在治疗后接受阿莫西西林治疗的儿童中,出血的复发率是治疗后的2-6倍 (P = .001).
结论:
- 单独使用阿莫西西林或与消血剂-抗组胺药物结合使用,对于儿童持续无症状的中耳液是无效的.
- 该研究质疑在这种情况下的耳视镜观测的有效性,并强调抗生素治疗缺乏益处.
- 较高的复发率表明OME的阿莫西西林治疗可能会造成伤害或缺乏解决.
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