Problemi correnti
Trattare o non trattare? Il caso dell’otite media acuta
SHOULD WE TREAT ACUTE OTITIS MEDIA WITH ANTIBIOTICS?
FEDERICO MARCHETTI
Pediatra di libera scelta, ASL di Lanciano-Vasto (Chieti)
Settembre 1998 - pagg. 453 -455
Abstract
The Author reviews the available evidence
on antibiotic treatment of Acute Otitis Media
(AOM) on the basis of current evidence,
including two recent metanalyses. Antibiotic
treatment of AOM, given the self-limited
character of AOM, produces little
additional benefit. This can be quantified in
earlier desappearance of hearache and reduced
risk of controlateral otitis. Complications
are exceedingly rare and never severe.
However, on the basis of available studies,
a few risk factors for failure (defined
as late resolution, complication, or recurrence)
can be identified for AOM: age less
than 15 months and/or attendance of a
day care centre, history of severe or recurrent
or very recent otitis, otorrhea. These at
risk children (usually representing not more
than 10% of cases) should receive a 5-day
course of antibiotic (amoxycillin), while the
others can be treated with antinflammatory
agents alone, with antibiotics restricted to
cases that fail to improve after 2-3 days.
This approach is advantageous also from
the point of view of prevention of antibiotic
resistance.
Parole chiave
Classificazione MeSH
Bibliografia
1. Marchetti F, Misticoni G, et al: La terapia
dell’otite media in etŕ pediatrica: la trasferibilitŕ
delle conoscenze scientifiche alla pratica
del quotidiano. Farmaci 18 (2), 45-55, 1994.
2. Fromm J, Culpepper L, Grob P, et al: Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network. BMJ 300, 582-6, 1990.
3. Fromm J, Culpepper L, Jacobs M, et al: Antimicrobials for acute otitis media? A review from the International Primary Care Network. BMJ 315, 98-102, 1997.
4. Van Buchen FAM, Peeters MF, van’t Hof MA: Acute otitis media: a new treatment strategy. BMJ 290, 1033-7, 1985.
5. Coen D: Un uso ecologico degli antibiotici nelle infezioni delle prime vie aeree. Ricerca & Pratica 12, 22-7, 1996.
6. Cohen ML: Epidemiology of drug resistance: implications for a post-antimicrobial era. Science 257, 1050-5,1992.
7. Stephenson J: Icelandic researchers are showing the way to bring down rates of antibiotic- resistent bacteria. JAMA 275, 175-6, 1996.
8. Swartz MN: Use of antimicrobial agents and drug resistance. N Engl J Med 337, 491-2, 1997.
9. Majeed A, Harris T: Acute otitis media in children. BMJ 315, 321-2, 1997.
10. Del Mar C, Glasziou P, Hayem M: Are antibiotics indicated as initial treatment for children with otitis media? A meta-analysis. BMJ 314, 1526-9, 1997.
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 124, 335-67, 1994.
12. Hathaway TJ, Katz HP, Dersherwitz RA, Marx TJ: Acute otitis media: who needs posttreatment follow-up? Pediatrics 94, 143-7, 1994.
13. Berman S: Otitis media in children. N Engl J Med 332, 1560-5, 1995.
14. Bussi R, Marchetti F, Murgia V, Pedrini A, Schievano P, et al: Gli antibiotici di riferimento sono ancora una risposta adeguata per la terapia delle infezioni delle prime vie aeree in etŕ pediatrica? Ricerca & Pratica 11, 147- 57, 1995.
15. Appleman CLM, Claessen JQPJ, Touw- Otton FWMM, Hordijk GJ, de Melker RA: Severity of inflammation of tympanic membrane as predictor of clinical course of recurrent otitis media. BMJ 306, 895, 1993.
16. Scott-Giebink G, Canafax DM, Kempthorne J: Antimicrobial treatment of acute otitis media. J Pediatr 119, 495-500, 1991.
17. Marchetti F: Antimicrobial treatment of acute otitis media. The Kangaroo 1, 29-33, 1994.
18. American Academy of Pediatrics: 1997 Red Book: XXIV Rapporto del Comitato sulle Malattie Infettive. CIS (ed.) 1997.
19. Carlin SA, Marchant CD, Shurin PA, et al: Host factors and early therapeutic response in acute otitis media. J Pediatr 118, 178-83, 1991.
20. Pichichero ME, Pichichero CL: Persistant acute otitis media: II. Antimicrobial treatment. Pediatr Infect Dis J 14, 183-8, 1995.
21. Marchetti F, Romero M: La prescrizione dei farmaci nella pratica pediatrica extraospedaliera. Prospettive in Pediatria 23, 313-23, 1993.
22. Chaput De Siantonge DM, Levine DF, Temple Savage I, et al: Trial of three-day and ten-day courses of amoxycillin in otitis media. BMJ 284, 1078-81, 1982.
23. Bain J, Murphy E, Ross F: Acute otitis media: clinical course among children who recived a short course of high dose of antibiotic. BMJ 291, 1243, 1985.
24. Sacher B, Cichetti B, Francano N, et al: Il trattamento breve dell’otite media acuta. Una ricerca collaborativa in pediatria ambulatoriale. Medico e Bambino 7, 20-22, 1990.
25. Hendrickse WA, Kusmiesz H, Shelton S, Nelson JD: Five vs ten days of therapy for acute otitis media. Pediatr Infect Dis J 7, 14- 23, 1988.
26. Pedrini A, Osti M, Bussi R, Murgia V, Schievano P, Marchetti F: Are the standard antibiotics an adequate response to the most common pediatric illnesses? In: Progress in Clinical Pharmacy. Clinical Trials and Pharmacoepidemiology. Scroccaro G, Martini N, Delporte JP, Husson C, Walker R (eds), European Society of Clinical Pharmacy, p. 269- 71, 1994.
27. Assael MB, Fornaro P, Gandini F, Marin M, Piccoli P, Tognetti D: Efficacia dell’amoxicillina nelle infezioni batteriche comuni. Medico e Bambino 4, 243-6, 1996.
28. Sagraves R, Maish W: Therapy of acute otitis media. Clinical and economic aspects. Pharm Ec 93, 353-63, 1994.
2. Fromm J, Culpepper L, Grob P, et al: Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network. BMJ 300, 582-6, 1990.
3. Fromm J, Culpepper L, Jacobs M, et al: Antimicrobials for acute otitis media? A review from the International Primary Care Network. BMJ 315, 98-102, 1997.
4. Van Buchen FAM, Peeters MF, van’t Hof MA: Acute otitis media: a new treatment strategy. BMJ 290, 1033-7, 1985.
5. Coen D: Un uso ecologico degli antibiotici nelle infezioni delle prime vie aeree. Ricerca & Pratica 12, 22-7, 1996.
6. Cohen ML: Epidemiology of drug resistance: implications for a post-antimicrobial era. Science 257, 1050-5,1992.
7. Stephenson J: Icelandic researchers are showing the way to bring down rates of antibiotic- resistent bacteria. JAMA 275, 175-6, 1996.
8. Swartz MN: Use of antimicrobial agents and drug resistance. N Engl J Med 337, 491-2, 1997.
9. Majeed A, Harris T: Acute otitis media in children. BMJ 315, 321-2, 1997.
10. Del Mar C, Glasziou P, Hayem M: Are antibiotics indicated as initial treatment for children with otitis media? A meta-analysis. BMJ 314, 1526-9, 1997.
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 124, 335-67, 1994.
12. Hathaway TJ, Katz HP, Dersherwitz RA, Marx TJ: Acute otitis media: who needs posttreatment follow-up? Pediatrics 94, 143-7, 1994.
13. Berman S: Otitis media in children. N Engl J Med 332, 1560-5, 1995.
14. Bussi R, Marchetti F, Murgia V, Pedrini A, Schievano P, et al: Gli antibiotici di riferimento sono ancora una risposta adeguata per la terapia delle infezioni delle prime vie aeree in etŕ pediatrica? Ricerca & Pratica 11, 147- 57, 1995.
15. Appleman CLM, Claessen JQPJ, Touw- Otton FWMM, Hordijk GJ, de Melker RA: Severity of inflammation of tympanic membrane as predictor of clinical course of recurrent otitis media. BMJ 306, 895, 1993.
16. Scott-Giebink G, Canafax DM, Kempthorne J: Antimicrobial treatment of acute otitis media. J Pediatr 119, 495-500, 1991.
17. Marchetti F: Antimicrobial treatment of acute otitis media. The Kangaroo 1, 29-33, 1994.
18. American Academy of Pediatrics: 1997 Red Book: XXIV Rapporto del Comitato sulle Malattie Infettive. CIS (ed.) 1997.
19. Carlin SA, Marchant CD, Shurin PA, et al: Host factors and early therapeutic response in acute otitis media. J Pediatr 118, 178-83, 1991.
20. Pichichero ME, Pichichero CL: Persistant acute otitis media: II. Antimicrobial treatment. Pediatr Infect Dis J 14, 183-8, 1995.
21. Marchetti F, Romero M: La prescrizione dei farmaci nella pratica pediatrica extraospedaliera. Prospettive in Pediatria 23, 313-23, 1993.
22. Chaput De Siantonge DM, Levine DF, Temple Savage I, et al: Trial of three-day and ten-day courses of amoxycillin in otitis media. BMJ 284, 1078-81, 1982.
23. Bain J, Murphy E, Ross F: Acute otitis media: clinical course among children who recived a short course of high dose of antibiotic. BMJ 291, 1243, 1985.
24. Sacher B, Cichetti B, Francano N, et al: Il trattamento breve dell’otite media acuta. Una ricerca collaborativa in pediatria ambulatoriale. Medico e Bambino 7, 20-22, 1990.
25. Hendrickse WA, Kusmiesz H, Shelton S, Nelson JD: Five vs ten days of therapy for acute otitis media. Pediatr Infect Dis J 7, 14- 23, 1988.
26. Pedrini A, Osti M, Bussi R, Murgia V, Schievano P, Marchetti F: Are the standard antibiotics an adequate response to the most common pediatric illnesses? In: Progress in Clinical Pharmacy. Clinical Trials and Pharmacoepidemiology. Scroccaro G, Martini N, Delporte JP, Husson C, Walker R (eds), European Society of Clinical Pharmacy, p. 269- 71, 1994.
27. Assael MB, Fornaro P, Gandini F, Marin M, Piccoli P, Tognetti D: Efficacia dell’amoxicillina nelle infezioni batteriche comuni. Medico e Bambino 4, 243-6, 1996.
28. Sagraves R, Maish W: Therapy of acute otitis media. Clinical and economic aspects. Pharm Ec 93, 353-63, 1994.