Rivista di formazione e aggiornamento professionale del pediatra e del medico di base, fondata nel 1982. In collaborazione con l'Associazione Culturale Pediatri.
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Linee guida

Otite media acuta in età pediatrica
Aggiornamento della Linea Guida della Regione Emilia-Romagna

Acute otitis media in childhood.
Update of the guidelines of the Emilia-Romagna Region

Simona Di Mario1, Carlo Gagliotti2, Maria Luisa Moro2, a nome del Gruppo "ProBA"

1Centro di documentazione sulla salute perinatale e riproduttiva - SaPeRiDoc, Servizio Assistenza Territoriale, Direzione generale sanità e politiche sociali e per l’integrazione; 2Area Rischio Infettivo, Agenzia Sanitaria e Sociale Regionale - Regione Emilia-Romagna, Bologna

Gennaio 2016 - pagg. 35 -40

Abstract
This guideline on acute otitis media in childhood updates the guideline published by the Emilia-Romagna Region in 2007. Acute otitis media (AOM) is a frequent condition in childhood, which causes repeated clinical visits, emergency unit visits, and inappropriate antibiotic prescribing. For the management of AOM, it recommends exclusive breastfeeding during the first 6 months and prolonged thereafter, avoiding passive cigarette smoking, hand washing as effective preventive measures, analgesic treatment for adequate pain control, and delayed antibiotic prescription unless specifically contraindicated. Amoxicillin (75 mg/ kg/day in three doses during five days) is the first choice when an antibiotic treatment is needed. Changes from 2007 guideline mainly refer to the simplification in the antibiotic treatment, with a two-step approach instead of a three-step approach. The guideline, based on the GRADE methodology, was developed by a multi-professional group of regional experts and was externally revised.
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Bibliografia
1. Di Mario S, Gagliotti C, Moro ML; a nome del Comitato tecnico-scientifico regionale “Progetto ProBA 2014”. La faringotonsillite in età pediatrica. Aggiornamento della Linea Guida della Regione Emilia-Romagna. Medico e Bambino 2015;34:442-7. 2. Kliegman R, Stanton B, St. Geme J, Schor N, Behrma R. Nelson Textbook of Pediatrics. 19th edition, 2011. 3. Liese JG, Silfverdal SA, Giaquinto C, et al. Incidence and clinical presentation of acute otitis media in children aged <6 years in European medical practices. Epidemiol Infect 2014;142:1778-88. 4. BCMA - British Columbia Medical Services Commission. Otitis media: acute otitis media (A-OM) & otitis media with effusion (OME). Victoria (BC), gennaio 2010. 5. Cohen R, Bingen E, Levy C, et al. Nasopharyngeal flora in children with acute otitis media before and after implementation of 7 valent pneumococcal conjugate vaccine in France. BMC Infect Dis 2012;12:52. 6. Spijkerman J, Prevaes SM, van Gils EJ, et al. Long-term effects of pneumococcal conjugate vaccine on nasopharyngeal carriage of S. pneumoniae, S. aureus, H. influenzae and M. catarrhalis. PLoS One 2012;7:e39730. 7. Martin JM, Hoberman A, Paradise JL, et al. Emergence of Streptococcus pneumoniae serogroups 15 and 35 in nasopharyngeal cultures from young children with acute otitis media. Pediatr Infect Dis J 2014;33:e286-e290. 8. van der Linden M, Imöhl M, Busse A, Rose M, Adam D. Bacterial spectrum of spontaneously ruptured otitis media in the era of pneumococcal conjugate vaccination in Germany. Eur J Pediatr 2015;174(3):355-64. 9. Marchisio P, Bianchini S, Baggi E, et al. A retrospective evaluation of microbiology of acute otitis media complicated by spontaneous otorrhea in children living in Milan, Italy. Infection 2013;41:629-35. 10. Hersh AL, Jackson MA, Hicks LA; American Academy of Pediatrics Committee on Infectious Diseases. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics 2013; 132:1146-54. 11. Gagliotti C, Buttazzi R, Moro ML, Di Mario S. Uso di antibiotici e resistenze antimicrobiche in età pediatrica. Rapporto Emilia- Romagna 2014. Bologna, agosto 2015. 12. Lass J, Odlind V, Irs A, Lutsar I. Antibiotic prescription preferences in paediatric outpatient setting in Estonia and Sweden. Springerplus 2013,2:124. 13. Di Mario S, Gagliotti C, Moro ML; Comitato tecnico-scientifico regionale “Progetto ProBA 2014”. Otite media acuta in età pediatrica. Linea guida regionale. Dossier 254- 2015. Bologna, maggio 2015. http://assr.regione. emilia-romagna.it/it/servizi/pubblicazioni/ dossier/doss254. 14. Tamburlini G. Frequenza al nido e rischio di malattia cronica e di problemi comportamentali. Medico e Bambino 2013;32:456-8. 15. Dagan R, Leibovitz E, Greenberg D, Yagupsky P, Fliss DM, Leiberman A. Early eradication of pathogens from middle ear fluid during antibiotic treatment of acute otitis media is associated with improved clinical outcome. Pediatr Infect Dis J 1998;17:776-82. 16. Le Saux N, Gaboury I, Baird M, et al. A randomized, double-blind, placebo-controlled noninferiority trial of amoxicillin for clinically diagnosed acute otitis media in children 6 months to 5 years of age. CMAJ 2005;172: 335-41. 17. Shaikh N, Hoberman A, Paradise JL, et al. Development and preliminary evaluation of a parent-reported outcome instrument for clinical trials in acute otitis media. Pediatr Infect Dis J 2009;28:5-8. 18. Casey JR, Block S, Puthoor P, Hedrick J, Almudevar A, Pichichero ME. A simple scoring system to improve clinical assessment of acute otitis media. Clin Pediatr (Phila) 2011; 50:623-9. 19. SIGN - Scottish Intercollegiate Guidelines Network. Diagnosis and management of childhood otitis media in primary care. A national clinical guideline. Edinburgh (Scotland), Scottish Intercollegiate Guidelines Network (SIGN). SIGN publication n. 66, 2003. 20. Marchetti F, Ronfani L, Conti Nibali S, Tamburlini G; Italian Study Group on Acute Otitis Media. Delayed prescription may reduce the use of antibiotics for acute otitis media: a prospective observational study in primary care. Arch Pediatr Adolesc Med 2005; 159:679-84. 21. Venekamp RP, Sanders S, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2013;1:CD000219. 22. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964-99. 23. Rovers MM, Glasziou P, Appelman CL, et al. Antibiotics for acute otitis media: a metaanalysis with individual patient data. Lancet 2006;386:1429-35. 24. Uitti JM, Laine MK, Tähtinen PA, Ruuskanen O, Ruohola A. Symptoms and otoscopic signs in bilateral and unilateral acute otitis media. Pediatrics 2013;131:e398-e405. 25. Forgie S, Zhanel G, Robinson J. Canadian Paediatric Society. Infectious Diseases and Immunization Committee. Management of acute otitis media. Paediatr Child Health 2009; 14:457-64. 26. Principi N, Marchisio P, Bellussi L. Otite media acuta: dalla diagnosi alla prevenzione. Linee guida italiane sulla diagnosi e prevenzione dell’otite media acuta. Febbraio 2010. 27. Dagan R. The use of pharmacokinetic/ pharmacodynamic principles to predict clinical outcome in paediatric acute otitis media. Int J Antimicrob Agents 2007;30:S127-S130. 28. Pichichero ME, Reed MD. Variations in amoxicillin pharmacokinetic/pharmacodynamic parameters may explain treatment failures in acute otitis media. Paediatr Drugs 2009;11:243-9. 29. Isla A, Trocóniz IF, Canut A, et al. Pharmacokinetic/ pharmacodynamic evaluation of amoxicillin, amoxicillin/clavulanate and ceftriaxone in the treatment of paediatric acute otitis media in Spain. Enferm Infecc Microbiol Clin 2011;29:167-73.

Corrispondenza: sdimario@regione.emilia-romagna.it