Otitis media and its consequences: beyond the earache
Otitis media and its consequences: beyond the earache
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DOI：
10.1016/s1473-3099(10)70012-8
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发表时间：
2010-03-01
影响因子：
56.3
通讯作者：
Pelton, Stephen I.
中科院分区：
文献类型：
--
作者：
Vergison, Anne;Dagan, Ron;Pelton, Stephen I.
一个由中耳和儿科感染多学科专家组成的国际小组开会探讨急性中耳炎管理的共识。在几位儿科传染病专家进行非正式讨论后，该小组扩大到包括更多在中耳疾病方面具有互补专长的专业人员。急性中耳炎是全世界儿童中非常常见的细菌感染，导致大多数国家的儿童过度使用抗生素，并导致发展中国家耳聋和化脓性并发症的严重负担。该小组试图超越围绕急性中耳炎指南的现有争议，并向临床医生和公共卫生官员提出他们对需要采取的行动的看法，以减少急性中耳炎引起的疾病负担以及由此产生的微生物抗生素耐药性。急性中耳炎的定义和诊断的准确性是识别可能从抗生素治疗中受益的儿童并消除不必要处方的关键步骤。尽管该小组同意抗生素是不分青红皂白地分发的，即使是那些似乎没有患病的儿童，但对于是否应该向所有适当诊断的儿童提供抗生素，没有达成共识，反映了广泛的实践和缺乏令人信服的证据。主要的一致关注是迫切需要减少不必要的抗生素处方，以防止抗生素耐药性的进一步增加。在发达国家和发展中国家，用现有和未来的病毒和细菌疫苗预防急性中耳炎似乎是影响疾病负担和后果的最有希望的方法。
An international group of multidisciplinary experts on middle-ear and paediatric infections met to explore where consensus exists on the management of acute otitis media. After informal discussions among several specialists of paediatric infectious disease, the group was expanded to include a larger spectrum of professionals with complementary expertise in middle-ear disease. Acute otitis media is a very common bacterial infection in children worldwide, leading to excessive antibiotic consumption in children in most countries and to a substantial burden of deafness and suppurative complications in developing countries. The group attempted to move beyond the existing controversies surrounding guidelines on acute otitis media, and to propose to clinicians and public health officials their views on the actions needed to be taken to reduce the disease burden caused by acute otitis media and the microbial antibiotic resistance from the resulting Use of antibiotics. Definition of acute otitis media and diagnostic accuracy are crucial steps to identify children who will potentially benefit from treatment with antibiotics and to eliminate unnecessary prescribing. Although the group agreed that antibiotics are distributed indiscriminately, even to children who do not seem to have the disease, no consensus could be reached on whether antibiotics should be given to all appropriately diagnosed children, reflecting the wide range of practices and lack of convincing evidence from observational studies. The major unanimous concern was an urgent need to reduce unnecessary prescribing of antibiotics to prevent further increases in antibiotic resistance. Prevention of acute otitis media with existing and future viral and bacterial vaccines seems the most promising approach to affect disease burden and consequences, both in developed and developing countries.