Abstract：
Update of the consensus on acute otitis media (AOM) (2012) and sinusitis (2013) following the introduction of pneumococcal vaccines in the immunization schedule, and related changes, such as epidemiological variation, colonization by of nonvaccine serotypes and emerging antimicrobial resistances. A majority of studies show that the introduction of the pneumococcal 13-valent conjugate vaccine has been followed by a reduction in the nasopharyngeal carriage of pneumococcus, with an increase in the proportion of drug-resistant nonvaccine serotypes. The diagnosis of AOM is still clinical, although more stringent criteria are proposed, which are based on the visualization of abnormalities in the tympanic membrane and the findings of pneumatic otoscopy performed by trained clinicians. The routine diagnosis of sinusitis is also clinical, and the use of imaging is restricted to the assessment of complications. Analgesia with acetaminophen or ibuprofen is the cornerstone of AOM management; watchful waiting or delayed antibiotic prescription may be suitable strategies in select patients. The first-line antibiotic drug in children with AOM and sinusitis and moderate to severe disease is still high-dose amoxicillin, or amoxicillin-clavulanic acid in select cases. Short-course regimens lasting 5-7 days are recommended for patients with uncomplicated disease, no risk factors and a mild presentation. In allergic patients, the selection of the antibiotic agent must be individualized based on severity and whether or not the allergy is IgE-mediated. In recurrent AOM, the choice between watchful waiting, antibiotic prophylaxis or surgery must be individualized based on the clinical characteristics of the patient.
摘要：
在免疫计划中引入肺炎球菌疫苗后，对急性中耳炎（AOM）（2012年）和鼻窦炎（2013年）的共识进行了更新。和相关的变化，如流行病学变异，非疫苗血清型定植和新出现的抗微生物耐药性。大多数研究表明，引入肺炎球菌13价结合疫苗后，鼻咽部携带的肺炎球菌减少，随着耐药非疫苗血清型比例的增加。AOM的诊断仍在临床，尽管提出了更严格的标准，这是基于鼓膜异常的可视化和由训练有素的临床医生进行的气动耳镜检查的结果。鼻窦炎的常规诊断也是临床的，影像学的使用仅限于评估并发症。对乙酰氨基酚或布洛芬的镇痛是AOM管理的基石；观察等待或延迟抗生素处方可能是选择患者的合适策略。患有AOM和鼻窦炎以及中重度疾病的儿童的一线抗生素药物仍然是大剂量阿莫西林，或阿莫西林-克拉维酸在某些情况下。对于无并发症的患者，建议使用持续5-7天的短程治疗方案。没有危险因素和轻度表现。在过敏患者中，抗生素药物的选择必须根据严重程度和过敏是否是IgE介导的情况进行个体化选择.在复发性AOM中，警惕等待之间的选择，抗生素预防或手术必须根据患者的临床特征进行个体化.
