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Evidenzbasierte Therapie der akuten Otitis media

Evidence-based therapy for acute otitis media

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Zusammenfassung

Die akute Otitis media (AOM) ist im Kindesalter eine der häufigsten Ursachen für Besuche beim niedergelassenen Arzt. Zur Prophylaxe nützlich sind Stillen und Vermeiden von Tabakrauchbelastung. Zur Behandlung der AOM im Kindesalter existieren viele unterschiedliche Empfehlungen, die nur z. T. auf aktuellen Studienergebnissen basieren. Wir berücksichtigen wissenschaftliche Literatur der höchsten Evidenzstufe, nämlich Metaanalysen randomisierter Studien und einzelne randomisierte Studien. Eine kausale antibiotische Therapie ist zu empfehlen bei einer AOM in Verbindung mit einer Otorrhö sowie bei einer bilateralen AOM von Kindern unter 2 Jahren. Bei Kindern über 2 Jahren ohne besondere Risikofaktoren kann im Sinne einer Nutzen-Risiko-Abwägung anfangs auf eine antibiotische Therapie verzichtet werden, wobei eine Verlaufskontrolle zu empfehlen ist. Ohrenschmerzen können wirkungsvoll mit Paracetamol oder Ibuprofen gelindert werden.

Abstract

In childhood, acute otitis media (AOM) is very common and one of the most frequent causes for consultations. Different practice guidelines exist, but not all of them are based on study results. In this article, we address issues with the definition of AOM, describe the spontaneous course of disease, and tell how to avoid risk factors associated with AOM. We base treatment recommendations for AOM on randomized controlled trials (RCTs) and provide systematic reviews of RCTs that give the strongest evidence for the effectiveness of health care interventions. Antibiotics seem to be most beneficial in children younger than 2 years with bilateral AOM and in children with AOM and otorrhoea. For children older than 2 years of age without additional risk factors, an initial observational approach together with further monitoring seems to be justified. Paracetamol and ibuprofen are effective in reducing pain associated with AOM in childhood.

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Literatur

  1. American Academy of Pediatrics, Subcommittee on Management of Acute Otitis Media (2004) Diagnosis and management of acute otitis media. Pediatrics 113: 1451–1465

    Article  Google Scholar 

  2. Bassler D, Forster J (2003) Otitis media. In: Bassler D, Forster J, Antes G (Hrsg) Evidenz-basierte Pädiatrie. Praxisnahes EBM-Handbuch für pädiatrische Diagnostik und Therapie. Thieme, Stuttgart New York

  3. Bertin L, Pons G, d’Athis P et al. (1996) A randomized, double-blind, multicentre controlled trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children. Fundam Clin Pharmacol 10: 387–392

    Article  PubMed  CAS  Google Scholar 

  4. Cohen R, Levy C, Boucherat M et al. (1998) A multicenter, randomized, double-blind trial of 5 versus 10 days of antibiotic therapy for acute otitis media in young children. J Pediatr 133: 634–639

    Article  PubMed  CAS  Google Scholar 

  5. Cohen R, Levy C, Boucherat M et al. (2001) Five vs. ten days of antibiotic therapy for acute otitis media in young children. Pediatr Infect Dis J 19: 458–463

    Google Scholar 

  6. Damoiseaux RA, Van Balen FA, Hoes AW et al. (1998) Antibiotic treatment of acute otitis media in children under two years of age: evidence based? Br J Gen Pract 48: 1861–1864

    PubMed  CAS  Google Scholar 

  7. Flynn CA, Griffin GH, Schultz JK (2004) Decongestants and antihistamines for acute otitis media in children. Cochrane Database Syst Rev 3: CD001727

    PubMed  Google Scholar 

  8. Foxlee R, Johansson A, Wejfalk J et al. (2006) Topical analgesia for acute otitis media. Cochrane Database Syst Rev 3: CD005657

    PubMed  CAS  Google Scholar 

  9. Glasziou PP, Del Mar CB, Sanders SL et al. (2004) Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 1: CD000219

    PubMed  Google Scholar 

  10. Hoberman A, Paradise JL, Reynolds EA et al. (1997) Efficacy of Auralgan for treating ear pain in children with acute otitis media. Arch Pediatr Adolesc Med 151: 675–678

    PubMed  CAS  Google Scholar 

  11. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SEA et al. (2000) Short course antibiotics for acute otitis media. Cochrane Database Syst Rev 2: CD001095

    PubMed  Google Scholar 

  12. Kurz R (2000) Modell des Präventionsprogramms gegen den plötzlichen Säuglingstod (SIDS) in der Steiermark. In: Kurz R, Kenner T, Poets CF (Hrsg) Der plötzliche Säuglingstod. Springer, Berlin Heidelberg New York, S 243–266

  13. Marcy M, Takata G, Chan LS et al. (2000) Management of acute otitis media. Evid Rep Technol Assess (Summ) 15: 1–4

    Google Scholar 

  14. Moon RY, Horne RS, Hauck FR (2007) Sudden infant death syndrome. Lancet 370: 1578–1587

    Article  PubMed  Google Scholar 

  15. Pichichero ME (2000) Acute otitis media: Part I. Improving diagnostic accuracy. Am Fam Physician 61: 2051–2056

    PubMed  CAS  Google Scholar 

  16. Pichichero ME, Poole MD (2001) Assessing diagnostic accuracy and tympanocentesis skills in the management of otitis media. Arch Pediatr Adolesc Med 155: 1137–1142

    PubMed  CAS  Google Scholar 

  17. Rosenfeld RM, Kay D (2003) Natural history of untreated otitis media. Laryngoscope 113: 1645–1657

    Article  PubMed  Google Scholar 

  18. Rosenfeld RM, Vertrees JE, Carr J et al. (1994) Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr 124: 355–367

    Article  PubMed  CAS  Google Scholar 

  19. Rovers MM, Schilder AG, Zielhuis GA et al. (2004) Otitis media. Lancet 363: 465–473. Erratum in: Lancet 363: 1080

  20. Rovers MM, Glasziou P, Appelman CL et al. (2006) Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet 368: 1429–1435

    Article  PubMed  CAS  Google Scholar 

  21. Rudberg RD (1954) Acute otitis media: comparative therapeutic results of sulphonamide and penicillin administered in various forms. Acta Otolaryngol 113: 1–79

    CAS  Google Scholar 

  22. Schäfer T, Borowski C, Diepgen TL et al. und die Konsensusgruppe des Aktionsbündnisses Allergieprävention (2004) Evidenz-basierte und konsentierte Leitlinie „Allergieprävention“. Allergo J 13: 252–260

    Google Scholar 

  23. Scottish Intercollegiate Guidelines Network (2003) Diagnosis and management of childhood otitis media in primary care. Scottish Intercollegiate Guidelines Network, Edinburgh

  24. Uhari M, Mäntysaari K, Niemelä M (1996) A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis 22: 1079–1083

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Neonatologie, Universitätskinderklinik Tübingen, Calwer-Straße 7, 72076 , Tübingen, Deutschland

    D. Bassler

  2. Kinderabteilung St. Hedwig, St.-Josefskrankenhaus, Freiburg, Freiburg, Deutschland

    J. Forster

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  1. D. Bassler
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  2. J. Forster
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Correspondence to D. Bassler.

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Bassler, D., Forster, J. Evidenzbasierte Therapie der akuten Otitis media. Monatsschr Kinderheilkd 156, 540–544 (2008). https://doi.org/10.1007/s00112-008-1753-4

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  • DOI: https://doi.org/10.1007/s00112-008-1753-4

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