Introduction

Reaching the point of treatment failure in the management of pediatric acute otitis media (AOM) is decision-changing, and is often associated with switching to a broader coverage antibiotic with/without middle ear surgical drainage. Yet, still there is no consensus on the definition of what is treatment failure, which may lead to confusion for clinical decision-making purposes. We sought to review the heterogeneity of treatment failure definitions in AOM.

Methods

We searched for relevant English language manuscripts using the following key-words: ['otitis media' (OM) or (AOM)] AND ['treatment failure' or 'failure' or 'response failure' or 'response'] AND 'human' in various electronic databases from 1/1/2005 through 10/31/2020.

Results

In the 60 retrieved papers, treatment failure was considered only when antibiotics had been prescribed beforehand, but not when watchful waiting had been adopted. We categorized the manuscripts into 5 major treatment failure definition subgroups, which occasionally overlapped: unimprovement or worsening of symptoms or signs of failure in otoscopy (n = 36), specialist(s) referral or hospital admission (n = 12), changing or adding antibiotic treatment (n = 22), failure to eradicate causative bacteria (n = 7) and failure as perceived by parents (n = 4).

Conclusions

We suggest a broader definition of AOM treatment failure including physical examination findings and degree of initial treatment response, which will enable an unbiased, uniform comparison of treatments for pediatric AOM.

中文翻译：

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小儿急性中耳炎的治疗失败：您如何定义？

介绍

在小儿急性中耳炎 (AOM) 的管理中达到治疗失败点是决定性的改变，并且通常与改用覆盖范围更广的抗生素（加/不加中耳手术引流）有关。然而，对于什么是治疗失败的定义仍然没有达成共识，这可能会导致临床决策的混乱。我们试图审查 AOM 中治疗失败定义的异质性。

方法

我们使用以下关键词搜索相关的英文手稿：['otitis media' (OM) or (AOM)] AND ['treatment failure' or 'failure' or 'response failure' or 'response'] AND 'human ' 从 2005 年 1 月 1 日到 2020 年 10 月 31 日，在各种电子数据库中。

结果

在检索到的 60 篇论文中，仅在事先开具抗生素处方时才考虑治疗失败，而在采取观察等待时则不考虑治疗失败。我们将手稿分为 5 个主要的治疗失败定义亚组，这些亚组偶尔会重叠：耳镜检查中的症状或体征未改善或恶化（n = 36）、专家转诊或住院（n = 12）、更改或添加抗生素治疗（n = 22），未能根除致病细菌（n = 7）和父母认为的失败（n = 4）。

结论

我们建议对 AOM 治疗失败进行更广泛的定义，包括体格检查结果和初始治疗反应的程度，这将有助于对儿科 AOM 的治疗进行公正、统一的比较。