儿童急性中耳炎的治疗课件_1.ppt

SOURCE INFORMATION N Engl J Med, 2011, 364:105-115(had been cited by 16 articles) From the Department of Pediatrics, University of Pittsburgh School of Medicine, USA. Correspondence author: Dr. Hoberman E-mail:hoberman@. Introduction of The New England Journal of Medicine (NEJM) 1812年创刊，由美国麻州医学协会所出版的同行评审性质之综合性医学期刊。 全科医学周刊，每年52期 出版风格：重要的研究成果、临床发现以及观点。注重文章的实用性，多为指导临床实践。 严格的审稿程序，稿件的处理流程通常需10—12周。来稿的刊用率约为7%。 BACKGROUND Acute otitis media(AOM) is the most frequently diagnosed illness in children in the US. Most children have routinely been treated with antimicrobial drugs in the US. A watchful-waiting strategy has long been applied in several countries to minimize the use of antimicrobial drugs. -Netherlands and Scotland4,5 -USA,2004,6,7 -Canada 8 AOM in children aged 6 to 23 months is “nonsevere” 6(mild otalgia and T≤ 39℃ during the preceding 24 hours) Diagnosis of AOM is uncertain.7 The watchful waiting strategy has been based on the results of clinical trials3 that showed relatively high rates of spontaneous improvement in children with acute otitis media. Limitations of earlier trials : -The lack of stringent diagnostic criteria; -The inclusion of few very young children; -Antimicrobial drug had limited efficacy or was administered in suboptimal doses.9 Rates of spontaneous improvement similar to the rates seen in those studies among children receiving placebo have not been found uniformly.6 Therefore, for children with AOM, the circumstances in which immediate antimicrobial treatment is the preferred strategy have remained unclear. OBJECTIVES To evaluate the extent to which antimicrobial treatment(Amoxicillin-clavulanate) and placebo treatment affect the course of both symptoms and signs of AOM in children aged 6 to 23 months . METHODS Eligibility and Enrollment Randomization Assessment of Symptoms Otoscopic Examination, Overall Assessment, and Management Outcomes Statistical Analysis 1.Eligibility and Enrollment From November