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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline.
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Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline.

机译：2004年AAP和AAFP临床实践指南发布后，急性中耳炎的管理。

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OBJECTIVES: Observation without initial antibiotic therapy was accepted as an option for acute otitis media (AOM) management in the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline. The guideline also recommended amoxicillin as the first-line treatment for most children, and analgesic treatment to reduce pain if it was present. Our objective was to compare the management of AOM after publication of the 2004 guideline. PATIENTS AND METHODS: We analyzed the National Ambulatory Medical Care Survey, 2002-2006 (N = 1114), which occurred in US physicians' offices. The patients were children aged 6 months to 12 years who were diagnosed with AOM. The time comparisons were the 30-month periods before and after the guideline. The main outcome was the encounter rate at which no antibiotic-prescribing was reported. Secondary outcomes were the identification of factors associated with encounters at which no antibiotic-prescribing was reported and antibiotic- and analgesic-prescribing rates. RESULTS: The rate of AOM encounters at which no antibiotic-prescribing was reported did not change after guideline publication (11%-16%; P = .103). Independent predictors of an encounter at which no antibiotic-prescribing was reported were the absence of ear pain, absence of reported fever, and receipt of an analgesic prescription. After guideline publication, the rate of amoxicillin-prescribing increased (40%-49%; P = .039), the rate of amoxicillin/clavulanate-prescribing decreased (23%-16%; P = .043), the rate of cefdinir-prescribing increased (7%-14%; P = .004), and the rate of analgesic-prescribing increased (14%-24%; P = .038). CONCLUSIONS: Although management of AOM without antibiotics has not increased after the publication of the 2004 American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline, children who did not receive antibiotics were more likely to have mild infections. In accordance with the guideline, the prescribing of amoxicillin and analgesics has increased. Contrary to the guideline, the prescribing of amoxicillin/clavulanate has decreased, whereas the prescribing of cefdinir has increased.
机译：目的：在2004年美国儿科学会和美国家庭医师学会临床实践指南中，接受不使用初始抗生素治疗的观察作为急性中耳炎（AOM）处理的一种选择。该指南还建议将阿莫西林作为大多数儿童的一线治疗药物，并建议使用止痛药来减轻疼痛（如果有的话）。我们的目标是比较2004年指南发布后AOM的管理。病人和方法：我们分析了2002-2006年国家门诊医疗调查（N = 1114），该调查发生在美国医师办公室。患者为6个月至12岁的被诊断患有AOM的儿童。时间比较是指南前后的30个月。主要结局是未报告抗生素处方的接触率。次要结果是确定与未见任何抗生素处方的情况相关的因素以及抗生素和止痛药的使用率。结果：指南发布后，未报告抗生素处方的AOM发生率未发生变化（11％-16％; P = .103）。没有发生抗生素处方的遭遇的独立预测因素是没有耳痛，没有发烧以及使用了止痛药。指南发布后，阿莫西林处方率增加（40％-49％; P = .039），阿莫西林/克拉维酸盐处方率降低（23％-16％; P = .043），头孢地尼比例处方药的使用率增加了（7％-14％; P = .004），止痛药的使用率增加了（14％-24％; P = .038）。结论：尽管在2004年美国儿科学会和美国家庭医师学会临床实践指南发布后，不使用抗生素的AOM的管理仍未增加，但未接受抗生素的儿童更可能患有轻度感染。根据该指南，阿莫西林和止痛药的处方有所增加。与该指南相反，阿莫西林/克拉维酸盐的处方减少，而头孢地尼的处方增加。

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