Ricerca
Il trattamento sintomatico dell’otite media acuta: uno studio collaborativo in Pediatria ambulatoriale
SINTOMATIC TREATMENT OF ACUTE OTITIS MEDIA: A COLLABORATIVE STUDY IN PAEDIATRIC GENERAL PRACTICE
LUCA RONFANI1, SERGIO CONTI NIBALI2, FEDERICO MARCHETTI3 PER IL GRUPPO DI LAVORO OMA-ACP*
1Centro per la Salute del Bambino/ONLUS, Trieste;
2Pediatra di famiglia, Messina;
3Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste * L’elenco dei partecipanti è riportato alla fine del lavoro.
Marzo 2002 - pagg. 170 -178
Abstract
Available evidence from controlled trials on antibiotic treatment of acute otitis media (AOM)
show that the benefit of antibiotic treatment is marginal. A large observational prospective
study aimed at evaluating to which extent symptomatic treatment alone was acceptable effective
and applicable in everyday practice, was carried out by 169 paediatric practicioners.
1277 children older than 12 months were included in the study. Criteria for antibiotic treatment
were: recurrent otitis media, othorrea, and persistence of fever or pain after 48-72
hours. Costs and benefits of treatment options were illustrated to the parents. Out of 1099
children eligible for symptomatic treatment, 743 (68%) were successfully treated without antibiotic.
None of these had complications at 30-day follow-up control. Amoxycillin was used
in 8 out of 10 children for whom antibiotic treatment was prescribed,. The study represents
an example of successful application of evidence-based medicine in the paediatric practice.
Parole chiave
Classificazione MeSH
Bibliografia
1. O’Neil P. Acute otitis media. BMJ 1999;319:
833-5.
2. Rivard CI, Fernandez A. Otitis media in children: frequency, risk factors, and research avenues. Epidemiologic Reviews 1993;15(2): 444-65.
3. Berman S. Otitis media in children. N Engl J Med 1995;332:1560-5.
4. Marchetti F, Misticoni G, et al. La terapia dell’otite media in età pediatrica: la trasferibilità delle conoscenze scientifiche alla pratica del quotidiano. Farmaci 1994;18(2):45-5.
5. Cazzato T, Pandolfini C, Campi R, Bonati M. Drug prescribing in out-patient children in Southern Italy. Eur J Clin Pharmacol 2001; 57:611-6.
6. Fromm J, Culpepper L, Grb P, et al. Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network. BMJ 1990;300:582-6.
7. Majeed A, Harris T. Acute otitis media in children. BMJ 1997;315:321-2.
8. Marchetti F. Trattare o non trattare? Il caso dell’otite media acuta. Medico e Bambino 1998;7:453-5.
9. Van Buchen FAM, Peeters MF, Van’t Hof MA. Acute otitis media: a new treatment strategy. BMJ 1985;290:1033-7.
10. Claessen JQ, Appelman CL, Tow-Otten FW, et al. A review of clinical trials regarding treatment of acute otitis media. Clin Otoralyngol 1992;17:251-7.
11. Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: meta-analysis of 5400 children from thirty-three randomized trials. J Pediatr 1994;124:355-67.
12. Del Mar C, Glasziou P, Haymen M. Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ 1997;314:1526-9.
13. Fromm J, Culpepper L, Jacobs M, et al. Antimicrobials for acute otitis media? A review from the International Primary Care Network. BMJ 1997;315:98-102.
14. Takata GS, Chan LS, Shekelle P, et al. Evidence assessment of management of acute otitis media: I. The role of antibiotics in treatment of uncomplicated acute otitis media. Pediatrics 2001;108:239-47
15. Mastroiacovo P, Bonati M. Quali evidenze nel trattamento delle patologie pediatriche più comuni? Prospettive in Pediatria 1998;28:195- 206.
16. Damoiseaux R, van Balen F, Hoes A, et al. Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years. BMJ 2000;320:350-4.
17. Mastroiacovo P. Piccole orecchie sorde all’antibiotico. Occhio Clinico Pediatria 2000;6: 10-2.
18. Little P. Gould C, Williamson I, et al. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ 2001;322:336-42.
19. Marolla F, Porro E. Le nuove linee guida per l’otite media acuta. Uno studio nell’ambulatorio del pediatra di famiglia. Medico e Bambino. Febbraio 2000, pagine elettroniche (www.medicoebambino.com).
20. Finkelstein JA, Davis RL, Dowell SF, et al. Reducing antibiotic in children: a randomised trial in 12 practices. Pediatrics 2001;108 (1):1-7.
21. Christakis DA, Zimmerman FJ, Wrighy JA, et al. A randomised controlled trial of point-ofcare evidence to improbe the antibiotic prescribing practices for otitis media in children. Pediatrics 2001;107(2):p.e.15.
22. Liberati A, editor. La medicina delle prove di efficacia. Roma: Il Pensiero Scientifico, 1997.
23. Haynes B, Haines A. Barriers and bridges to evidence based clinical practice. BMJ 1998; 317:273-6.
24. Feder G, Eccles M, Grol R, Griffiths C, Grimshaw J. Clinical guidelines: using clinical guidelines. BMJ 1999;318:728-30.
25. Rosser WW. Application of evidence from randomised controlled trials to general practice. Lancet 1999;353:661-4.
26. Rodriguez WJ, Schwartz RH. Streptococcus pneumoniae causes otitis media with higher fever and more readness of tympanic membranes than Haemophilus influenzae or Moraxella catharrhalis. Pediatr Infect Dis J 1999;18:942- 44.
27. Nasrin D, Collignon PJ, Roberts L, et al. Effect of B lactam antibiotic use in children on pneumococcal resistence to penicillin: prospective cohort study. BMJ 2002;324:28.
28. Butler C, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throat. BMJ 1998;317:632-7.
29. Cates C. An evidence based approach to reducing antibiotic use in children with acute otitis media: controlled before and after study. BMJ 1999;318:715-6.
30. Damoiseaux RAMJ. Antibiotics for acute otitis media in infancy. Based on fear or on facts? Paediatric and Perinatal Drug Therapy 2000;4(2):58-61.
31. Appelman CLM, Claessen JQPJ, Touw-Otten FWMM, et al. Co-amoxiclav in recurrent acute otitis media: placebo controlled study. BMJ 1991;303:1450-2.
32. Damoiseaux RAMJ, de Melker RA, Ausems MJE, van Balen FAM. Reasons for nonguideline- based antibiotic prescriptions for acute otitis media in the Netherlands. Family Practice 1999;16 (1):50-3.
33. Van Zuijlen DA, Schilder AGM, Van Balen FAM, Hoes AW. National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media. Pediatr Infect Dis J 2001;20:140-4.
34. Ghaffar FA, Wordemann M, McCracken GH. Acute mastoiditis in children: a seventeenyear experience in Dallas, Texas. Pediatr Infect Dis J 2001;20;376-80.
35. Dowell SF, Marcy SM, Phillips WR, et al. Otitis media-Principles of judicious of antimicrobial agents. Pediatrics (suppl) 1998;101 (1):165-71.
36. Klein JO. Review of consensus reports on management of acute acute otitis media. Pediatr Infect Dis J 1999;18:1152-5.
37. Gruppo di lavoro sulle linee guida per la prescrizione ambulatoriale degli antibiotici nelle infezioni pediatriche delle vie respiratorie. Prescrizione ambulatoriale degli antibiotici nelle infezioni respiratorie. Medico e Bambino 2000;7:438-40.
38. Dowell SF, Butler JC, Giebink GS, et al. Acute otitis media: management and surveillance in an era of pneumococcal resistence-a report from the Drug-resistant Streptococcus pneumoniae therapeutic working group. Pediatr Infect Dis J 1999;18;1-9.
39. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE. Treatment of acute otitis media with a shortened course of antibiotics: a metaanalysis. JAMA 1998;279:1736-42
40. Schrag SJ, Pena C, Fernandez J, et al. Effect of short-course, high-dose amoxicillin therapy on resistant pneumococcal carriage: a randomised trial. JAMA 2001 Jul 4;286(1):49-56.
41. Preston K. Pneumatic otoscopy: a review of literature. Issues Compr Pediatr Nurs 1998; 21:117-28.
42. Chan LS, Takata GS, Shekelle P, et al. Evidence assessment of management of acute otitis media: II. Research gaps and priorities for future research. Pediatrics 2001;108:248-54.
2. Rivard CI, Fernandez A. Otitis media in children: frequency, risk factors, and research avenues. Epidemiologic Reviews 1993;15(2): 444-65.
3. Berman S. Otitis media in children. N Engl J Med 1995;332:1560-5.
4. Marchetti F, Misticoni G, et al. La terapia dell’otite media in età pediatrica: la trasferibilità delle conoscenze scientifiche alla pratica del quotidiano. Farmaci 1994;18(2):45-5.
5. Cazzato T, Pandolfini C, Campi R, Bonati M. Drug prescribing in out-patient children in Southern Italy. Eur J Clin Pharmacol 2001; 57:611-6.
6. Fromm J, Culpepper L, Grb P, et al. Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network. BMJ 1990;300:582-6.
7. Majeed A, Harris T. Acute otitis media in children. BMJ 1997;315:321-2.
8. Marchetti F. Trattare o non trattare? Il caso dell’otite media acuta. Medico e Bambino 1998;7:453-5.
9. Van Buchen FAM, Peeters MF, Van’t Hof MA. Acute otitis media: a new treatment strategy. BMJ 1985;290:1033-7.
10. Claessen JQ, Appelman CL, Tow-Otten FW, et al. A review of clinical trials regarding treatment of acute otitis media. Clin Otoralyngol 1992;17:251-7.
11. Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: meta-analysis of 5400 children from thirty-three randomized trials. J Pediatr 1994;124:355-67.
12. Del Mar C, Glasziou P, Haymen M. Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ 1997;314:1526-9.
13. Fromm J, Culpepper L, Jacobs M, et al. Antimicrobials for acute otitis media? A review from the International Primary Care Network. BMJ 1997;315:98-102.
14. Takata GS, Chan LS, Shekelle P, et al. Evidence assessment of management of acute otitis media: I. The role of antibiotics in treatment of uncomplicated acute otitis media. Pediatrics 2001;108:239-47
15. Mastroiacovo P, Bonati M. Quali evidenze nel trattamento delle patologie pediatriche più comuni? Prospettive in Pediatria 1998;28:195- 206.
16. Damoiseaux R, van Balen F, Hoes A, et al. Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years. BMJ 2000;320:350-4.
17. Mastroiacovo P. Piccole orecchie sorde all’antibiotico. Occhio Clinico Pediatria 2000;6: 10-2.
18. Little P. Gould C, Williamson I, et al. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ 2001;322:336-42.
19. Marolla F, Porro E. Le nuove linee guida per l’otite media acuta. Uno studio nell’ambulatorio del pediatra di famiglia. Medico e Bambino. Febbraio 2000, pagine elettroniche (www.medicoebambino.com).
20. Finkelstein JA, Davis RL, Dowell SF, et al. Reducing antibiotic in children: a randomised trial in 12 practices. Pediatrics 2001;108 (1):1-7.
21. Christakis DA, Zimmerman FJ, Wrighy JA, et al. A randomised controlled trial of point-ofcare evidence to improbe the antibiotic prescribing practices for otitis media in children. Pediatrics 2001;107(2):p.e.15.
22. Liberati A, editor. La medicina delle prove di efficacia. Roma: Il Pensiero Scientifico, 1997.
23. Haynes B, Haines A. Barriers and bridges to evidence based clinical practice. BMJ 1998; 317:273-6.
24. Feder G, Eccles M, Grol R, Griffiths C, Grimshaw J. Clinical guidelines: using clinical guidelines. BMJ 1999;318:728-30.
25. Rosser WW. Application of evidence from randomised controlled trials to general practice. Lancet 1999;353:661-4.
26. Rodriguez WJ, Schwartz RH. Streptococcus pneumoniae causes otitis media with higher fever and more readness of tympanic membranes than Haemophilus influenzae or Moraxella catharrhalis. Pediatr Infect Dis J 1999;18:942- 44.
27. Nasrin D, Collignon PJ, Roberts L, et al. Effect of B lactam antibiotic use in children on pneumococcal resistence to penicillin: prospective cohort study. BMJ 2002;324:28.
28. Butler C, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throat. BMJ 1998;317:632-7.
29. Cates C. An evidence based approach to reducing antibiotic use in children with acute otitis media: controlled before and after study. BMJ 1999;318:715-6.
30. Damoiseaux RAMJ. Antibiotics for acute otitis media in infancy. Based on fear or on facts? Paediatric and Perinatal Drug Therapy 2000;4(2):58-61.
31. Appelman CLM, Claessen JQPJ, Touw-Otten FWMM, et al. Co-amoxiclav in recurrent acute otitis media: placebo controlled study. BMJ 1991;303:1450-2.
32. Damoiseaux RAMJ, de Melker RA, Ausems MJE, van Balen FAM. Reasons for nonguideline- based antibiotic prescriptions for acute otitis media in the Netherlands. Family Practice 1999;16 (1):50-3.
33. Van Zuijlen DA, Schilder AGM, Van Balen FAM, Hoes AW. National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media. Pediatr Infect Dis J 2001;20:140-4.
34. Ghaffar FA, Wordemann M, McCracken GH. Acute mastoiditis in children: a seventeenyear experience in Dallas, Texas. Pediatr Infect Dis J 2001;20;376-80.
35. Dowell SF, Marcy SM, Phillips WR, et al. Otitis media-Principles of judicious of antimicrobial agents. Pediatrics (suppl) 1998;101 (1):165-71.
36. Klein JO. Review of consensus reports on management of acute acute otitis media. Pediatr Infect Dis J 1999;18:1152-5.
37. Gruppo di lavoro sulle linee guida per la prescrizione ambulatoriale degli antibiotici nelle infezioni pediatriche delle vie respiratorie. Prescrizione ambulatoriale degli antibiotici nelle infezioni respiratorie. Medico e Bambino 2000;7:438-40.
38. Dowell SF, Butler JC, Giebink GS, et al. Acute otitis media: management and surveillance in an era of pneumococcal resistence-a report from the Drug-resistant Streptococcus pneumoniae therapeutic working group. Pediatr Infect Dis J 1999;18;1-9.
39. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE. Treatment of acute otitis media with a shortened course of antibiotics: a metaanalysis. JAMA 1998;279:1736-42
40. Schrag SJ, Pena C, Fernandez J, et al. Effect of short-course, high-dose amoxicillin therapy on resistant pneumococcal carriage: a randomised trial. JAMA 2001 Jul 4;286(1):49-56.
41. Preston K. Pneumatic otoscopy: a review of literature. Issues Compr Pediatr Nurs 1998; 21:117-28.
42. Chan LS, Takata GS, Shekelle P, et al. Evidence assessment of management of acute otitis media: II. Research gaps and priorities for future research. Pediatrics 2001;108:248-54.