|
.................................... Search the net .................................... |
Paediatric Pulmonology and Allergology
2005 April, Vol. VIII, No. 1 (2846-2851)
EUROPEAN CONTROVERSIES IN THE MANAGEMENT OF SINUSITIS AND OTITIS IN CHILDREN
Matti Korppi
Kuopio University Children’s Hospital, Kuopio, Finland
Acute otitis media is common in young children. In nearly all cases, acute otitis media is a consequence of upper respiratory infection. Two-thirds of all children have experienced at least one acute otitis media episode before 2 years of age. Viral rhinosinusitis leading in <2% of cases to persistent nasal discharge or bacterial sinusitis. Streptococcus pneumoniae, non-capsulated Haemophilus influenzae and Branhamella (Moraxella) catarrhalis are the main bacterial pathogens in otitis, sinusitis and persistent nasal discharge cases in children. Pneumococcal resistance to penicillins and/or macrolides is an increasing problem in many countries, both figures being on average >30% with large variations between different countries. In most countries, about 20% of H. influenzae and >80% of B. catarrhalis produce beta-lactamase. Frequent respiratory infections, recurrent antibiotic courses and high bacterial carriage are common in young children under 2–3 years of age. Therefore, the way how the common respiratory infections, including otitis, sinusitis and persistent nasal discharge cases, are treated in young children, influences significantly on antibiotic resistance in the whole population. In this paper, the author refers the Finnish evidence-based guidelines for acute otitis media and sinusitis in children, and the Dutch way to treat acute otitis media in children. The recommendations are mainly based on systematic reviews on otitis, sinusitis and persistent nasal discharge from the Cochrane Electronic Library.