「小児急性中耳炎診療ガイドライン」の検討 Treatment outcome of acute otitis media in children treated with the newly released guideline in Japan

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著者

    • 林 達哉 HAYASHI Tatsuya
    • 旭川医科大学 耳鼻咽喉科・頭頸部外科 Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical College
    • 安部 裕介 ABE Yusuke
    • 旭川医科大学 耳鼻咽喉科・頭頸部外科 Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical College
    • 上田 征吾 UEDA Seigo
    • 旭川医科大学 耳鼻咽喉科・頭頸部外科 Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical College
    • 大高 隆輝 OTAKA Ryuki
    • 旭川医科大学 耳鼻咽喉科・頭頸部外科 Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical College
    • 坂東 伸幸 BANDOH Nobuyuki
    • 旭川医科大学 耳鼻咽喉科・頭頸部外科 Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical College
    • 片田 彰博 KATADA Akihiro
    • 旭川医科大学 耳鼻咽喉科・頭頸部外科 Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical College

抄録

著者版2006年5〜9月に北海道内12病院の耳鼻咽喉科外来を受診した小児急性中耳炎患者146症例(男児75例、女児71例、3ヵ月〜12歳・中央値24ヵ月)を対象に2006年発表の「小児急性中耳炎診療ガイドライン(本ガイドライン)」の妥当性と課題について検討した。本ガイドラインの特徴は重症度別の治療選択を推奨していること、重症度決定には臨床所見のみならず鼓膜所見を加味していること、選択抗菌薬はペニシリン系を中心とし鼓膜切開も治療の選択肢に加えていることなどが挙げられる。その結果、全体の84%の症例が本ガイドラインに沿った抗菌薬の選択が行われ、86%の症例で本ガイドラインに沿って鼓膜切開が行われた。その結果、治療成績は初診後7日以内に鼓膜スコアが0に達した早期治癒群が146例中88例(73%)と良好であり、治癒遷延群が11例(9%)、早期治癒後4週間以内の再燃群が5例(4%)、入院加療を要した入院加療群が1例で残る16例は再来院がなく経過が追えなかった。以上より本ガイドラインは日本における抗菌薬使用適正化の第一歩として十分な役割を果すことが期待された。

Treatment outcome of acute otitis media (AOM) in children was assessed when treated with the newlyreleased clinical guideline in Japan. Our goal of this study is to clarify how appropriate this guideline is andwhether it has any difficulties in use for daily clinical practice. Twelve hospitals in Hokkaido, Japan participatedin this study between May and September 2006. Patients were diagnosed and treated according to the guideline. Swab samples were obtained from nasopharynx at their first visits to detect pathogens. Patients wererequested to visit the clinic 3 days, a week, 2 weeks, and 4 weeks after their first visit.<BR>A hundred forty-six patients'records were analyzed on the initial stages, initial scores of the tympanicmembranes (TMs), isolated bacteria, and treatment information including antibiotics and myringotomy theyunderwent. Twenty-five patients dropped out of the study, therefore 121 patients were followed until their TMscores reached zero. A hundred ninety-eight bacteria were isolated from 133 patients. Fifty-seven percent of <I>S. pneumoniae</I> were penicillin resistant and 59% of<I> H. influenzae</I> were β-lactamase non-producing ampicillin resistantstrains. A hundred twenty-two of 146 patients (84%) underwent antibiotic therapy recommended in the guideline.Sixty-three of 76 recommended cases (83%) underwent myringotomy. Eleven cases (9%) still hadinflammatory changes in their TMs even a week after their first visit. However, 8 of these 11 cases achievedTM score 0 in 2 weeks, and so did the others in 4 weeks after their first visit. Moreover, their symptom scoresreached zero in a week for all patients.<BR>Improvement of symptoms and TM findings was satisfactory when patients with AOM in children weretreated with the guideline. This guideline would be expected to play an important role to spread the appropriateuse of antibiotics in this country.

収録刊行物

  • Otology Japan  

    Otology Japan 17(2), 118-123, 2007-05-25 

    THE JAPAN OTOLOGICAL SOCIETY

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各種コード

  • NII論文ID(NAID)
    10021296965
  • NII書誌ID(NCID)
    AN10358085
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    09172025
  • データ提供元
    CJP書誌  CJP引用  IR  J-STAGE 
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