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Diagnosis, Microbial Epidemiology, andAntibioticTreatment of Acute Otitis Media in Children
A Systematic Review
Disusun Oleh:• Selvi Sulistia Ningsih (H1A010041)• Suluh Bayu Waskito (H1A010027)
Pembimbing:dr. Afif Rahmawan, Sp.THT M.Kes
PENDAHULUANTahun 2006 pengeluaran sebesar $350 per anak dengan diagnosis OMA
Diagnosis dan manajemen yang tepat memiliki konsekuensi yang signifikan dalam pelayanan kesehatan dan anggaran belanja
TUJUAN
Untuk melakukan tinjauan sistematis pada diagnosis OMA, pengobatan, dan asosiasi penggunaan vaksin pneumococcal conjugate
heptavalent (PCV7) dengan OMA mikrobiologi.
METODE• SELEKSI
Data diambil dari
•Pubmed•Cochrane Controlled Clinical Trials Register Database•Review efektivitas Cochrane Database•Web Sains dari artikel yang dipublikasikan Januari 1999 sampai Juli 2010 pada diagnosis OMA•Hasil pengobatan•Asosiasi penggunaan PCV7 dengan perubahan mikrobiologi
Inklusi•Anak berusia 4 minggu sampai 18 tahun•Studi observasional untuk PCV7 dan pertanyaan diagnostik •OMA mikrobiologi sebelum dan setelah implementasi PCV7
Eksklusi•Anak dengan imunodefisiensi dan anomali kraniofasial•Percobaan terkontrol secara acak (RCT), uji klinis terkontrol, dan studi observasional dimasukkan dalam pencarian awal; laporan kasus, ikhtisar klinis, editorial, dan pedoman praktek•Dokter dalam pelatihan
Kriteria Restriksi
Data Abstraksi
Dua peneliti (T.R.C. , M.A.L.) ditinjau dari judul independen dan abstrak untuk artikel yang berpotensi dan relevan.
Ketidaksepakatan diselesaikan dengan konsensus, peneliti utama (P.G.S. , G.S.T.) memutuskan jika ada perselisihan.
Penyajian biostatistika data untuk analisis data terkait pengobatan-efek samping
PENILAIAN KUALITAS•Untuk meninjau kualitas RCT
Kriteria JADAD
•Untuk menilai kualitas sistematis
Kriteria AMSTAR
•Untuk menilai kualitas studi diagnostik
Kriteria QUADAS
SINTESIS DATA
studi diagnostik dan studi tentang penggunaan PCV7 dan perubahan epidemiologi mikroba OMA Ringkasan data ANALISIS
Studi pengobatan artikel diidentifikasi dianalisis perbandingan berdasarkan jenis antibiotik bukan kelas antibiotik kecuali kelompok amoxsisilin dan ampisilin
HASIL
HASIL
OMA Diagnosis
• gejala infeksi akut
• bukti radang telinga tengah
• adanya efusi dari telinga tengah
EPIDEMIOLOGI mikrobakteri OMA dan
PCV 7
Ampisilin atau Amoksisilin vs Placebo
Antibiotik Segera vs Antibiotik Terlambat2
melaporkan
tingkat
keberhasilan
yang lebih tingg
i deng
an pengobatan
segera
menggunakan Antibiotik
2 tidak menemukan
perbedaannya
Efek berbahaya jangka pendek dari terapi Antibiotik
Efek merugikan dari Pengobatan Antibiotik jangka
panjangTidak satu pun dari studi yang mengevaluasi
tingkat efek samping jangka panjang pengobatan antibiotik, termasuk resistensi
antibiotik
Perbandingan Efektivitas Antibiotik
Amoxicillin clavulanate lebih unggul dari cefaclor
10 hari amoxicillinclavulanate lebih unggul dari 5 hari azitromisin
5 hari amoksisilin-klavulanat tidak seefektif 7 sampai 10 hari
5 hari ceftibuten tidak seefektif dibanding 10 hari ceftibuten
Antibiotik Terkait Efek Samping
Efek samping yang sering terjadi pada pengobatan ini adalah DIARE
KESIMPULAN
Temuan otoskopik sangat
penting untuk diagnosis OMA yang akurat.
OMA mikrobiologi
telah berubah dengan
penggunaan PCV7.
Antibiotik sederhana lebih efektif
daripada tidak ada pengobatan tetapi menyebabkan efek
buruk di 4-10 % dari anak-anak.
Kebanyakan antibiotik memiliki
keberhasilan klinis yang sebanding.
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