儿童复发性急性中耳炎抗菌药物预防疗效的系统回顾和荟萃分析》（A Systematic Review and Meta-Analysis of the Efficacy of Antimicrobial Chemoprophylaxis for Recurrent Acute Otitis Media in Children）。
Timothy Davies, Xicheng Peng, Joseph Salem, Zeynep C. Elcioglu, Anna Kremneva, Mei-yin Gruber, Kristijonas Milinis, Michael W. Mather, Jason Powell, Sunil Sharma
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Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long-term effects and contribution to global antibiotic resistance.</p>\n </section>\n \n <section>\n \n <h3> Design and Setting</h3>\n \n <p>A comprehensive literature search was undertaken using Medline (1946–October 2023) and Embase (1974–October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children < 18 years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta-analysis was carried out using random-effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the <i>I</i>\n <sup>2</sup> statistic.</p>\n </section>\n \n <section>\n \n <h3> Main Outcome Measures</h3>\n \n <p>The effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes. Secondary outcomes: assessment of antimicrobial agents and outcomes in children with risk factors.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Assessment of qualitative data was performed on 20 studies (<i>n</i> = 2210). No controlled trials were identified post-multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. 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A Systematic Review and Meta-Analysis of the Efficacy of Antimicrobial Chemoprophylaxis for Recurrent Acute Otitis Media in Children
Objectives
Acute otitis media (AOM) is a common childhood infection. Recurrent AOM affects a subset of children, resulting in an adverse impact on quality of life, socioeconomic disadvantage, and risk of long-term sequelae. Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long-term effects and contribution to global antibiotic resistance.
Design and Setting
A comprehensive literature search was undertaken using Medline (1946–October 2023) and Embase (1974–October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children < 18 years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta-analysis was carried out using random-effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the I2 statistic.
Main Outcome Measures
The effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes. Secondary outcomes: assessment of antimicrobial agents and outcomes in children with risk factors.
Results
Assessment of qualitative data was performed on 20 studies (n = 2210). No controlled trials were identified post-multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. Quantitative meta-analysis on nine pre-PCV studies (n = 1087) demonstrated antimicrobial chemoprophylaxis reduced any episode of AOM with a risk ratio 0.59 (95% CI 0.45–0.77).
Conclusion
Families and clinicians must balance marginal short-medium term benefit (based on pre-PCV data), and the potential for adverse effects to that individual, and the societal risk of antimicrobial resistance with prolonged antibiotic use.
期刊介绍：
Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with:
current otorhinolaryngological practice
audiology, otology, balance, rhinology, larynx, voice and paediatric ORL
head and neck oncology
head and neck plastic and reconstructive surgery
continuing medical education and ORL training
The emphasis is on high quality new work in the clinical field and on fresh, original research.
Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject.
• Negative/null results
In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.
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