今日の臨床サポート 今日の臨床サポート

著者: 中村豊 ゆたかこどもクリニック

監修: 渡辺博 帝京大学老人保健センター

著者校正済:2025/06/10
現在監修レビュー中
参考ガイドライン:
  1. 日本耳科学会など:小児急性中耳炎診療ガイドライン 2024年版
  1. 小児外来診療における抗菌薬適正使用のためのワーキンググループ:小児上気道炎に対する抗菌薬適正使用のすすめ 
  1. 厚生労働省抗微生物薬適正使用の手引き 第三版
患者向け説明資料

改訂のポイント:
  1. 『小児急性中耳炎診療ガイドライン 2024年版』『抗微生物薬適正使用の手引き 第三版』を参照して下記の点を加筆修正した。
  1. 中耳炎の起炎菌は、インフルエンザ菌が増加して第1位となったのに対し、肺炎球菌は1/3に減少した。インフルエンザ菌は耐性化率が上昇しているのに対し、肺炎球菌の耐性化率は減少している。
  1. アモキシシリン(AMPC)やセフジトレンピボキシル(CDTR-PI)の用量が耐性菌に対応するために初回投与開始時点から高用量投与に増量されている。
  1. 中等症以上の重症度判定をした場合、鼓膜切開の是非を検討することが求められている。

概要・推奨   

  1. 中耳炎の診断は臨床所見と鼓膜所見を組み合わせて行う(推奨度1)
  1. 年齢・臨床症状・鼓膜所見より重症度の判定を行う(推奨度2)
  1. 重症度に基づき初期治療方針を決定する(推奨度1)
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病態・疫学・診察 

疾患情報(疫学・病態)  
  1. 中耳炎は、ウイルスが呼吸器粘膜に感染することにより、粘膜浮腫が起こり耳管機能障害をきたすため、上気道に存在する病原菌が中耳に侵入し炎症を生じると考えられる。穿孔がなければ外耳からの感染は考えられない。
  1. 肺炎球菌、インフルエンザ菌ならびにモラクセラ・カタラーリスが起炎菌の多くをしめる。以前は薬剤耐性化が問題となっていたが、抗菌薬適正使用の普及や肺炎球菌ワクチンの定期接種化を受けて耐性化はいくぶん改善傾向にある。
  1. 1歳までに75%が罹患、7歳までに40%が4回以上罹患する頻度の高い感染症である[1][2]
  1. かぜ症状で受診した児の鼓膜を観察すると中耳に液の貯留を認めることがある。特に乳児の滲出性中耳炎の約50%は急性中耳炎発症後に生じるとされる[3]。低年齢児では、急性炎症消退後に遷延する中耳貯留液の可能性もあり、鼓膜所見から急性中耳炎と滲出性中耳炎を鑑別することが難しい。低年齢児は反復性中耳炎の危険因子でもあり、滲出性中耳炎ではなく、急性中耳炎としての治療を必要とすることが多い。
 
  1. 日本のガイドライン
  1. わが国の小児急性中耳炎の診療のためのガイドラインとして、日本耳科学会などによる「小児急性中耳炎診療ガイドライン」(以下「日本耳科学会ガイドライン」)と、小児外来診療における抗菌薬適正使用のためのワーキンググループ作成の「小児上気道炎および関連疾患に対する抗菌薬使用ガイドライン」(以下「小児外来診療における抗菌薬適正使用のためのワーキンググループ作成ガイドライン」)、厚生労働省が出した、抗微生物薬適正使用の手引き 第三版(以下「厚生労働省ガイドライン」)の3つがある。それぞれにおける中耳炎の定義は次のとおりである。
  1. 日本耳科学会ガイドライン[4]
  1. 急性に発症した中耳の感染症で、耳痛、発熱、耳漏を伴うことがある。『急性に発症』とは、本人の訴えあるいは両親や保護者に急性症状が発見され、急性症状が持続する間に受診した場合としている。持続については3週間を超えない。
  1. 小児外来診療における抗菌薬適正使用のためのワーキンググループ作成ガイドライン[5]
  1. 急性の耳漏がみられるかあるいは中耳に貯留液を認め、かつ耳痛などの感染症状と鼓膜の明らかな発赤・強い腫脹・水疱形成などの感染所見を1つ以上認めるものとしている。
  1. 厚生労働省ガイドライン[6]
  1. 耳痛、発熱、耳漏を伴うことがある急性に発症した中耳の感染症。耳管経由で中耳腔まで炎症、感染が波及して生じる。
  1. 日本耳科学会ガイドラインは2013年版までは正確な鼓膜所見の評価や鼓膜切開などの耳処置を施行できる耳鼻科医を対象としていたが、2018年版以降では小児急性中耳炎の診療に携わるすべての医師を対象と変更して小児科医も対象に含めた。小児外来診療における抗菌薬適正使用のためのワーキンググループ作成ガイドラインと厚生労働省ガイドラインはすべての一般診療医を対象としている。
  1. 厚生労働省ガイドラインは第二版が2019年12月に刊行され、初版に含まれていなかった中耳炎が取り上げられた。急性中耳炎は抗菌薬使用が多い疾患であることから、一般診療医が抗菌薬の必要性を判断するための基準と初期選択薬について簡明に記載されている。2023年発行の第三版では抗菌薬に関する項目にわずかな修正がみられる。
 
  1. 海外のガイドライン
  1. 小児の急性中耳炎に関するガイドラインは諸外国からも公刊されている。日本耳科学会ガイドラインで触れられているのは、米国、カナダ、イタリアのガイドラインである。小児外来診療における抗菌薬適正使用のためのワーキンググループ作成ガイドラインではオランダのガイドラインに触れている。このほかにもSuzukiらはヨーロッパのガイドラインを17編集めて比較し[7]、 Siddiq Sは米国と英国のガイドライン(NICE)との比較を行っている[8]
  1. 多くの国のガイドラインで共通している診断の決め手は
  1. 急性発症である(耳痛や発熱など)。
  1. 中耳腔に液貯留が証明されている。
  1. 中耳の急性炎症の徴候(鼓膜の膨隆など)。
  1. この点は、わが国のガイドラインも同様で、重要なことは鼓膜の正確な観察である。
 
問診・診察のポイント  
  1. 耳痛の有無を聞くこと(夜間の不機嫌は重要なサインである。乳児では耳を引っ張る、こする、触る)。

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最新のエビデンスに基づいた二次文献データベース「今日の臨床サポート」。
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文献 

Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP.
Otitis media: diagnosis and treatment.
Am Fam Physician. 2013 Oct 1;88(7):435-40.
Abstract/Text Acute otitis media is diagnosed in patients with acute onset, presence of middle ear effusion, physical evidence of middle ear inflammation, and symptoms such as pain, irritability, or fever. Acute otitis media is usually a complication of eustachian tube dysfunction that occurs during a viral upper respiratory tract infection. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms isolated from middle ear fluid. Management of acute otitis media should begin with adequate analgesia. Antibiotic therapy can be deferred in children two years or older with mild symptoms. High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin. Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate. Otitis media with effusion is defined as middle ear effusion in the absence of acute symptoms. Antibiotics, decongestants, or nasal steroids do not hasten the clearance of middle ear fluid and are not recommended. Children with evidence of anatomic damage, hearing loss, or language delay should be referred to an otolaryngologist.

PMID 24134083
Kerschner JE, et al. Otitis Media, In: Kliegman RM eds Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA Elsevier 2016: chap 640. p3085.
Rosenfeld RM, Kay D.
Natural history of untreated otitis media.
Laryngoscope. 2003 Oct;113(10):1645-57. doi: 10.1097/00005537-200310000-00004.
Abstract/Text OBJECTIVE/HYPOTHESIS: Data from cohort studies and untreated groups in randomized controlled trials can be identified through systematic literature review and synthesized with meta-analysis to estimate natural history of acute otitis media (AOM) and otitis media with effusion (OME).
STUDY DESIGN: Systematic literature review and meta-analysis.
METHOD: Source articles were identified by MEDLINE search through August 2002 plus manual crosschecks of bibliographies and published meta-analyses. Data were abstracted independently by two investigators and combined with random effects meta-analysis to estimate spontaneous resolution, 95% confidence intervals (CI), and heterogeneity. Sensitivity analysis was performed.
RESULTS: Sixty-three articles met inclusion criteria. AOM symptoms improved within 24 hours without antibiotics in 61% of children (95% CI, 50-72%), rising to 80% by 2 to 3 days (95% CI, 69-90%). Suppurative complications were comparable if antibiotics were withheld (0.12%) or provided (0.24%). Children entered recurrent AOM trials with a mean rate of 5.5 or more annual episodes but averaged only 2.8 annual episodes while on placebo (95% CI, 2.2-3.4). No AOM episodes occurred in 41%, and only 17% remained otitis prone (3 or more episodes). OME after untreated AOM had 59% resolution by 1 month (95% CI, 50-68%) and 74% resolution by 3 months (95% CI, 68-80%). OME of unknown duration had 28% spontaneous resolution by 3 months (95%, CI 14-41%), rising to 42% by 6 months (95% CI, 35-49%). In contrast, chronic OME had only 26% resolution by 6 months and 33% resolution by 1 year.
CONCLUSIONS: The natural history of otitis media is very favorable. Combined estimates of spontaneous resolution provide a benchmark against which to judge new or established interventions. The need for surgery in children with recurrent AOM or chronic OME should be balanced against the likelihood of timely spontaneous resolution and the potential risk of learning, language, or other adverse sequelae from persistent middle ear effusion. Further research is needed to identify prognostic factors that can target children unlikely to improve spontaneously for earlier intervention.

PMID 14520089
日本耳科学会、日本小児耳鼻咽喉科学会、日本耳鼻咽喉科免疫アレルギー感染症学会:小児急性中耳炎診療ガイドライン2024年版.金原出版、2024.
草刈章ら,小児上気道炎および関連疾患に対する抗菌薬使用ガイドライン,外来小児科2:146-173,2005.
厚生労働省健康・生活衛生局感染症対策部 感染症対策課編:抗微生物薬適正使用の手引き 第三版、厚生労働省健康・生活衛生局感染症対策部 感染症対策課、2023.
Suzuki HG, Dewez JE, Nijman RG, Yeung S.
Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines.
BMJ Open. 2020 May 5;10(5):e035343. doi: 10.1136/bmjopen-2019-035343. Epub 2020 May 5.
Abstract/Text OBJECTIVES: To appraise European guidelines for acute otitis media (AOM) in children, including methodological quality, level of evidence (LoE), astrength of recommendations (SoR), and consideration of antibiotic stewardship.
DESIGN: Systematic review of the literature.
DATA SOURCES: Three-pronged search of (1) databases: Medline, Embase, Cochrane library, Guidelines International Network and Trip Medical Database; (2) websites of European national paediatric associations and (3) contact of European experts. Data were collected between January 2017 and February 2018.
ELIGIBILITY CRITERIA: National guidelines of European countries for the clinical management of AOM in children aged <16 years.
DATA EXTRACTION AND SYNTHESIS: Data were extracted using tables constructed by the research team. Guidelines were graded using AGREE II criteria. LoE and SoR were compared. Guidelines were assessed for principles of antibiotic stewardship.
RESULTS: AOM guidelines were obtained from 17 or the 32 countries in the European Union or European Free Trade Area. The mean AGREE II score was ≤41% across most domains. Diagnosis of AOM was based on similar signs and symptoms. The most common indication for antibiotics was tympanic membrane perforation/otorrhoea (14/15; 93%). The majority (15/17; 88%) recommended a watchful waiting approach to antibiotics. Amoxicillin was the most common first-line antibiotic (14/17; 82%). Recommended treatment duration varied from 5 to 10 days. Seven countries advocated high-dose (75-90 mg/kg/day) and five low-dose (30-60 mg/kg/day) amoxicillin. Less than 60% of guidelines used a national or international scale system to rate level of evidence to support recommendations. Under half of the guidelines (7/17; 41%) referred to country-specific microbiological and antibiotic resistance data.
CONCLUSIONS: Guidelines for managing AOM were similar across European countries. Guideline quality was mostly weak, and it often did not refer to country-specific antibiotic resistance patterns. Coordinating efforts to produce a core guideline which can then be adapted by each country may help improve overall quality and contribute to tackling antibiotic resistance.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
PMID 32371515
Siddiq S, Grainger J.
The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013.
Arch Dis Child Educ Pract Ed. 2015 Aug;100(4):193-7. doi: 10.1136/archdischild-2013-305550. Epub 2014 Nov 12.
Abstract/Text
PMID 25395494
土田晋也 急性中耳炎 横田俊平ら編: 直伝 小児の薬の選び方・使いかた, 改訂5版, 南山堂 東京, 2020.
Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, Joffe MD, Miller DT, Rosenfeld RM, Sevilla XD, Schwartz RH, Thomas PA, Tunkel DE.
The diagnosis and management of acute otitis media.
Pediatrics. 2013 Mar;131(3):e964-99. doi: 10.1542/peds.2012-3488. Epub 2013 Feb 25.
Abstract/Text This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM. In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships. The practice guideline underwent comprehensive peer review before formal approval by the AAP. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem.

PMID 23439909
Bertin L, Pons G, d'Athis P, Duhamel JF, Maudelonde C, Lasfargues G, Guillot M, Marsac A, Debregeas B, Olive G.
A randomized, double-blind, multicentre controlled trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children.
Fundam Clin Pharmacol. 1996;10(4):387-92. doi: 10.1111/j.1472-8206.1996.tb00590.x.
Abstract/Text Two hundred and nineteen children (boys: 56%, girls: 44%) were included in a randomized, double-blind, multicentre (4 centres) controlled trial designed to assess the efficacy and safety of ibuprofen (IBU) in the treatment of 1 to 6 year-old children with otoscopically proven acute otitis media (AOM), either unilateral or bilateral. They randomly received 10 mg/kg IBU (n = 71), or acetaminophen (PARA) (n = 73) or placebo (PLA) (n = 75), orally, tid, for 48 hours. All received oral cefaclor (Alfatil, Lilly, France) for seven days. They were evaluated before (D0) and at the end of treatment (D2). The main criterion of response was the aspect (landmarks and color) of the tympanic membrane assessed on a semi-quantitative scale from 0 to 6. Other criteria, assessed on semi-quantitative scales, included relief of pain (0 or 1), rectal temperature (0 to 2), and overall evaluation by parents of the improvement of quality of life on three items: appetite (0 to 2), sleep (0 to 2), and playing activity (0 to 2). The results at D2 were as follows: there was no significant difference between treatment groups as to the main criterion, but only a trend for IBU and PARA to do better than PLA but not for IBU to do better than PARA. From these data there is no argument to emphasize the utility of non-steroidal anti-inflammatory drugs (NSAIDs) in treating the inflammatory signs of the tympanic membrane in otitis. There was a statistically significant difference between treatment groups at D2 for pain, IBU being superior to PLA (P < 0.01): 7%, 10% and 25% of the children were still suffering at D2 in the IBU, PARA and PLA treatment groups, respectively. The difference between PARA and PLA for pain was not statistically significant. There was no significant difference between treatment groups for the other criteria. All treatments were well and equally tolerated. Although no significant difference was found between the treatment groups on the aspect of the tympanic membrane, the efficacy of IBU was evidenced on the relief of pain, the symptom that most disturbs the child.

PMID 8871138
大久保祐輔: Dr Kidの小児診療 抗菌薬のエビデンス, 医学書院 東京, 2020.
Rovers MM, Glasziou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, Gaboury I, Little P, Hoes AW.
Antibiotics for acute otitis media: a meta-analysis with individual patient data.
Lancet. 2006 Oct 21;368(9545):1429-35. doi: 10.1016/S0140-6736(06)69606-2.
Abstract/Text BACKGROUND: Individual trials to test effectiveness of antibiotics in children with acute otitis media have been too small for valid subgroup analyses. We aimed to identify subgroups of children who would and would not benefit more than others from treatment with antibiotics.
METHODS: We did a meta-analysis of data from six randomised trials of the effects of antibiotics in children with acute otitis media. Individual patient data from 1643 children aged from 6 months to 12 years were validated and re-analysed. We defined the primary outcome as an extended course of acute otitis media, consisting of pain, fever, or both at 3-7 days.
FINDINGS: Significant effect modifications were noted for otorrhoea, and for age and bilateral acute otitis media. In children younger than 2 years of age with bilateral acute otitis media, 55% of controls and 30% on antibiotics still had pain, fever, or both at 3-7 days, with a rate difference between these groups of -25% (95% CI -36% to -14%), resulting in a number-needed-to-treat (NNT) of four children. We identified no significant differences for age alone. In children with otorrhoea the rate difference and NNT, respectively, were -36% (-53% to -19%) and three, whereas in children without otorrhoea the equivalent values were -14% (-23% to -5%) and eight.
INTERPRETATION: Antibiotics seem to be most beneficial in children younger than 2 years of age with bilateral acute otitis media, and in children with both acute otitis media and otorrhoea. For most other children with mild disease an observational policy seems justified.

PMID 17055944
鈴木賢二, 黒野祐一, 池田勝久, ほか. 第6回耳鼻咽喉科領域感染症臨床分離菌全国サーベイランス結果報告. 日本耳鼻咽喉科感染症・エアロゾル学会会誌. 2020;8(3):193-211.
Kaleida PH, Casselbrant ML, Rockette HE, Paradise JL, Bluestone CD, Blatter MM, Reisinger KS, Wald ER, Supance JS.
Amoxicillin or myringotomy or both for acute otitis media: results of a randomized clinical trial.
Pediatrics. 1991 Apr;87(4):466-74.
Abstract/Text A total of 536 infants and children with acute otitis media were randomly assigned to one of six consistent year-long regimens involving the treatment of nonsevere episodes with either amoxicillin or placebo, and severe episodes with either amoxicillin, amoxicillin and myringotomy, or, in children aged 2 years or older, placebo and myringotomy. Nonsevere episodes had more favorable outcomes in subjects assigned to treatment with amoxicillin than with placebo, as measured by the proportions that resulted in initial treatment failure (3.9% vs 7.7%, P = .009) and the proportions in which middle-ear effusion was present at 2 and 6 weeks after onset (46.9% vs 62.5%, P less than .001; and 45.9% vs 51.5%, P = .09, respectively). In subjects whose entry episode was non-severe, those assigned to amoxicillin treatment had less average time with effusion during the succeeding year than those assigned to placebo treatment (36.0% vs 44.4%, P = .004), but recurrence rates of acute otitis media in the two groups were similar. In the 2-year-and-older age group, severe episodes resulted in more initial treatment failures in subjects assigned to receive myringotomy alone than in subjects assigned to receive amoxicillin with, or without, myringotomy (23.5% vs 3.1% vs 4.1%, P = .006). In the study population as a whole, severe episodes in subjects assigned to receive amoxicillin alone, and amoxicillin with myringotomy, had comparable outcomes. It is concluded that children with acute otitis media should routinely be treated with amoxicillin (or an equivalent antimicrobial drug). The data provide no support for the routine use of myringotomy either alone or adjunctively.

PMID 2011422
Flynn CA, Griffin GH, Schultz JK.
Decongestants and antihistamines for acute otitis media in children.
Cochrane Database Syst Rev. 2004;(3):CD001727. doi: 10.1002/14651858.CD001727.pub2.
Abstract/Text BACKGROUND: Acute otitis media (AOM) is a common and important source of morbidity in children, although most cases resolve spontaneously. While frequently recommended, decongestant and antihistamine therapy is of unclear benefit.
OBJECTIVES: To determine the efficacy of decongestant and antihistamine therapy in children with AOM on outcomes of AOM resolution, symptom resolution, medication side effects, and complications of AOM.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2003); MEDLINE (January 1966 to December 2003), EMBASE (January 1990 to July 2003) and reference lists of articles for this updated review. We also contacted study authors and pharmaceutical companies.
SELECTION CRITERIA: Randomized controlled trials evaluating decongestant or antihistamine treatment for children with AOM were included. Patient-oriented outcomes were considered most relevant. There were no quality or language restrictions.
DATA COLLECTION AND ANALYSIS: Investigators independently evaluated studies for inclusion, performed validity assessments, and completed data extraction. Dichotomous data were pooled to generate relative risks; homogeneity was assessed using approximate chi-square tests.
MAIN RESULTS: Fifteen trials involving 2695 people were included. Only the combined decongestant-antihistamine group demonstrated statistically lower rates of persistent AOM at the two week period (fixed relative risk (RR) 0.76; 95% confidence interval (CI) 0.60 to 0.96; number needed to treat (NNT) 10). No benefit was found for early cure rates, symptom resolution, prevention of surgery or other complications. There was a five to eight -fold increased risk of side effects for those receiving an intervention, which reached statistical significance for all decongestant groupings. Validity sub analyses demonstrated that lower quality studies found benefit, while analysis of those studies with higher validity scores found no benefit of treatment.
REVIEWERS' CONCLUSIONS: Given lack of benefit and increased risk of side effects, these data do not support the use of decongestant treatment in children with AOM. There was a small statistical benefit from combination medication use but the clinical significance is minimal and study design may be biasing the results. Thus, the routine use of antihistamines for treating AOM in children cannot be recommended.

PMID 15266451
Suzuki K, Kurono Y, Ikeda K, Watanabe A, Iwamoto A, Totsuka K, Kaku M, Iwata S, Kadota J, Hanaki H.
Nationwide surveillance of 6 otorhinolaryngological infectious diseases and antimicrobial susceptibility pattern in the isolated pathogens in Japan.
J Infect Chemother. 2015 Jul;21(7):483-91. doi: 10.1016/j.jiac.2015.03.005. Epub 2015 Mar 24.
Abstract/Text The Japanese Three Academic Societies Joint Antimicrobial Susceptibility Surveillance Committee has conducted a nationwide surveillance on antimicrobial susceptibility patterns and rates of isolation in 6 otolaryngological diseases. The surveillance program was conducted in the otorhinolaryngological departments of 29 universities, and their 26 affiliated hospitals. Patients suffering from acute otitis media, chronic otitis media, acute nasal sinusitis, chronic nasal sinusitis, acute tonsillitis, and peritonsillar abscess between January 2011 and June 2012 were investigated. The collected swab or incision samples were cultivated for microbial identification, and the drug susceptibility of detected bacteria was measured at the Kitasato University Research Center for Infections and Antimicrobials. The surveillance focused on three gram-positive bacteria (Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus), three gram-negative bacteria (Haemophilus influenzae, Moraxella Catarrhalis, and Pseudomonas aeruginosa), and three anaerobic bacteria (Peptostreptococcus spp., Prevotella spp., and Fusobacterium spp.). Bacterial susceptibility to 39 antimicrobial drugs was investigated. We compared bacterial isolation ratio of each disease in this surveillance from those of past 4 times surveillance which we performed formerly, and we also compared percentage of main drug resistant strains from those of past 4 times surveillance. The age composition between this time and former surveillances was not statistically significant by student-t test. We were unable to completely resolve the rise in resistant bacteria, such as methicillin-resistant S. aureus, penicillin-resistant S. pneumoniae, penicillin-intermediate resistant S. pneumoniae, beta-lactamase non-producing ampicillin-resistant H. influenzae, beta-lactamase producing ampicillin-resistant H. influenzae, and beta-lactamase producing amoxicillin clavulanic acid-resistant H. influenzae. We suggest promoting the proper usage of antimicrobial drugs in order to avoid the spread of these bacteria.

Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
PMID 26004175
Suzuki K, Kurono Y, Ikeda K, Hotomi M, Yano H, Watanabe A, Matsumoto T, Takahashi Y, Hanaki H.
The seventh nationwide surveillance of six otorhinolaryngological infectious diseases and the antimicrobial susceptibility patterns of the isolated pathogens in Japan.
J Infect Chemother. 2020 Sep;26(9):890-899. doi: 10.1016/j.jiac.2020.05.020. Epub 2020 Jul 1.
Abstract/Text The Japanese Three Academic Societies Joint Antimicrobial Susceptibility Surveillance Committee conducted a nationwide surveillance on six otorhinolaryngological diseases and investigated the antimicrobial susceptibility patterns and isolation rates of the causative pathogens. The surveillance program was conducted in the otorhinolaryngological departments of 12 universities, and 36 affiliated hospitals and clinics. Patients with acute otitis media (children under six years old), chronic otitis media, acute nasal sinusitis, chronic nasal sinusitis, acute tonsillitis, and peritonsillar abscess (over 20 years old) between December 2015 and June 2017 were investigated. The collected swab or incision samples were cultivated for microbial identification, and the antimicrobial susceptibility of the detected bacteria was measured at the Kitasato University Research Center for Infections and Antimicrobials. The surveillance focused on three gram-positive bacteria (Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus), three gram-negative bacteria (Haemophilus influenzae, Moraxella catarrhalis, and Pseudomonas aeruginosa), and three anaerobic bacteria (anaerobic gram-positive cocci, Prevotella spp., Porphyromonas spp., and Fusobacterium spp.). Bacterial susceptibility to 40 antimicrobial agents was investigated. We were unable to completely mitigate the rise in the occurrence of resistant bacteria, such as methicillin-resistant S. aureus, penicillin-resistant S. pneumoniae, penicillin-intermediate resistant S. pneumoniae, beta-lactamase non-producing ampicillin-resistant H. influenzae, and beta-lactamase producing ampicillin-resistant H. influenzae. We suggest promoting the proper usage of antimicrobial agents to prevent the spread of these bacteria. We also suggested that immunization with pneumococcal vaccines is useful for decreasing the occurrence of otorhinolaryngological infectious diseases caused by pneumococci.

Copyright © 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
PMID 32622623
American Academy of Family Physicians; American Academy of Otolaryngology-Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion.
Otitis media with effusion.
Pediatrics. 2004 May;113(5):1412-29. doi: 10.1542/peds.113.5.1412.
Abstract/Text The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline "Otitis Media With Effusion in Young Children," which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children 1 to 3 years old with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced-practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use pneumatic otoscopy as the primary diagnostic method and distinguish OME from acute otitis media. The subcommittee made recommendations that clinicians should 1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME, 2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk, and 3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or diagnosis (if onset is unknown). The subcommittee also made recommendations that 4) hearing testing be conducted when OME persists for 3 months or longer or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME, 5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected, and 6) when a child becomes a surgical candidate (tympanostomy tube insertion is the preferred initial procedure). Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that 1) population-based screening programs for OME not be performed in healthy, asymptomatic children, and 2) because antihistamines and decongestants are ineffective for OME, they should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management. The subcommittee gave as options that 1) tympanometry can be used to confirm the diagnosis of OME and 2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery) and provide additional relevant information such as history of acute otitis media and developmental status of the child. The subcommittee made no recommendations for 1) complementary and alternative medicine as a treatment for OME, based on a lack of scientific evidence documenting efficacy, or 2) allergy management as a treatment for OME, based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed. The purpose of this guideline is to inform clinicians of evidence-based methods to identify, monitor, and manage OME in children aged 2 months through 12 years. The guideline may not apply to children more than 12 years old, because OME is uncommon and the natural history is likely to differ from younger children who experience rapid developmental change. The target population includes children with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for use by providers of health care to children, including primary care and specialist physicians, nurses and nurse practitioners, physician assistants, audiologists, speech-language pathologists, and child-development specialists. The guideline is applicable to any setting in which children with OME would be identified, monitored, or managed. This guideline is not intended as a sole source of guidance in evaluating children with OME. Rather, it is designed to assist primary care and other clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all children with this condition and may not provide the only appropriate approach to diagnosing and managing this problem.

PMID 15121966
Sugita G, Hotomi M, Sugita R, Kono M, Togawa A, Yamauchi K, Funaki T, Yamanaka N.
Genetic characteristics of Haemophilus influenzae and Streptococcus pneumoniae isolated from children with conjunctivitis-otitis media syndrome.
J Infect Chemother. 2014 Aug;20(8):493-7. doi: 10.1016/j.jiac.2014.04.015. Epub 2014 Jun 20.
Abstract/Text Acute conjunctivitis is the most common ocular disorders among children and frequently concomitant with acute otitis media (AOM) as conjunctivitis-otitis syndrome. In this study, we evaluated prevalence of causative pathogens and PCR-based genotypes of Haemophilus influenzae and Streptococcus pneumoniae among children with conjunctivitis-otitis media syndrome. Nontypeable H. influenzae (NTHi) is identified most often at 61.8% in conjunctiva exudates followed by S. pneumoniae at 28.2% and Moraxella catarrhalis at 19.1%. Genetic β-lactamase nonproducing ampicillin resistant (gBLNAR) strains of NTHi and genetic penicillin resistant S. pneumoniae (gPRSP) were identified at 72.1% and at 74.2% among conjunctiva isolates by polymerase chain reaction (PCR), respectively. Pneumococcal strains having either ermB or mefE genes were identified at 93.5% among conjunctiva isolates. The restriction fragment of patterns of 89.7% pairs of H. influenzae isolates and 100% pairs of pneumococcal isolates from conjunctiva exudates, middle ear fluids (MEFs) and nasopharyngeal swabs were identical. In contrast to the previous reports, most prevalent strains from conjunctivitis-otitis media syndrome was BLNAR H. influenzae in this study. The causative pathogen responsible for acute conjunctivitis will be originated from the nasopharynx. In the absence of MEFs one can possibly rely on the nasopharyngeal culture to guide an appropriate treatment.

Copyright © 2014. Published by Elsevier Ltd.
PMID 24953451
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、渡邉裕次、井ノ口岳洋、梅田将光および日本医科大学多摩永山病院 副薬剤部長 林太祐による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、 著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※同効薬・小児・妊娠および授乳中の注意事項等は、海外の情報も掲載しており、日本の医療事情に適応しない場合があります。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適応の査定において保険適応及び保険適応外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適応の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
中村豊 : 報酬額(KMバイオロジクス(株))[2025年]
監修:渡辺博 : 特に申告事項無し[2025年]

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