{"id":660,"date":"2011-02-09T10:23:21","date_gmt":"2011-02-09T01:23:21","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=660"},"modified":"2015-08-07T10:27:22","modified_gmt":"2015-08-07T01:27:22","slug":"2%e6%ad%b3%e4%bb%a5%e4%b8%8b%e3%81%ae%e5%ad%90%e4%be%9b%e3%81%ae%e6%80%a5%e6%80%a7%e4%b8%ad%e8%80%b3%e7%82%8e%e6%b2%bb%e7%99%82%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e6%8a%97%e8%8f%8c%e8%96%ac%e3%81%ae","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=660","title":{"rendered":"2\u6b73\u4ee5\u4e0b\u306e\u5b50\u4f9b\u306e\u6025\u6027\u4e2d\u8033\u708e\u6cbb\u7642\u306b\u5bfe\u3059\u308b\u6297\u83cc\u85ac\u306e\u4f7f\u7528"},"content":{"rendered":"<p>\u3010\u6587\u732e\u540d\u3011<br \/>\n\u2028Alejandro,et al. Treatment of Acute Otitis Media in Children under 2 Years of Age. N Engl J Med 2011; 364:105-115\u2028\u2028\u2028<\/p>\n<p>\u3010\u8981\u7d04\u3011<br \/>\n\u3010\u80cc\u666f\u3011\u2028<br \/>\n2\u6b73\u4ee5\u4e0b\u306e\u4e73\u5e7c\u5150\u306e\u6025\u6027\u4e2d\u8033\u708e\u306e\u6cbb\u7642\u306b\u304a\u3051\u308b\u63a8\u5968\u306b\u95a2\u3057\u3066\u306fImmediate antimicrobial treatment\u3068Watchfull waiting\u3068\u69d8\u3005\u306a\u610f\u898b\u304c\u3042\u308b\u3002<\/p>\n<p>\u3010\u65b9\u6cd5\u3011<br \/>\n\u2028\u5f93\u6765\u3088\u308a\u3082\u53b3\u683c\u306acriteria\u3067\u6025\u6027\u4e2d\u8033\u708e\u3068\u8a3a\u65ad\u3055\u308c\u305f\u751f\u5f8c6\uff5e23\u304b\u6708\u306e\u4e73\u5e7c\u5150291\u4eba\u3092\u7121\u4f5c\u70ba\u306b\u30a2\u30e2\u30ad\u30b7\u30b7\u30ea\u30f3\u30fb\u30af\u30e9\u30d6\u30e9\u30f3\u9178(\u4ee5\u4e0bABx)\u6295\u4e0e\u7fa4\u3068\u30d7\u30e9\u30bb\u30dc\u7fa4\u306b\u5272\u308a\u4ed8\u3051\u300110\u65e5\u9593\u6cbb\u7642\u3092\u884c\u3063\u305f\u3002\u2028\u53b3\u683c\u306acriteria\u3068\u306f\u4ee5\u4e0b\u306e3\u3064\u3092\u6e80\u305f\u3059\u3082\u306e\u3068\u5b9a\u7fa9\u3057\u305f\u3002<br \/>\n\u2028\u246048\u6642\u9593\u4ee5\u5185\u306e\u767a\u75c7\u2028<br \/>\n\u2461AOM-SOS score\u30003\u70b9\u4ee5\u4e0a<br \/>\n\u2028\u2462\u4e2d\u8033\u306e\u6240\u898b\uff08\u4e2d\u8033\u306e\u6d78\u51fa\u6db2and\u4e2d\u7b49\u5ea6\u3082\u3057\u304f\u306f\u91cd\u5ea6\u306e\u9f13\u819c\u81a8\u9686or\u8efd\u5ea6\u306e\u9f13\u819c\u81a8\u9686\u3068\u8033\u75dbor\u9f13\u819c\u306e\u8457\u660e\u306a\u767a\u8d64\uff09\u2028<\/p>\n<p>\u9664\u5916\u57fa\u6e96\u2028<br \/>\n\u4ed6\u306e\u6025\u6027\u75be\u60a3\u3042\u308a\uff0f\u6162\u6027\u75be\u60a3\u3042\u308a\uff0f\u30a2\u30e2\u30ad\u30b7\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc<br \/>\n\u202896\u6642\u9593\u4ee5\u5185\u306b1\u3064\u4ee5\u4e0a\u306e\u6297\u751f\u5264\u5185\u670d\u6b74\u3042\u308a\uff0f48\u6642\u9593\u4ee5\u4e0a\u306e\u8033\u75db\uff0f\u9f13\u819c\u7a7f\u5b54\u2028\u3000<br \/>\n\u203b\u3000AOM-SOS score\uff080\uff5e14\u70b9\u6e80\u70b9\uff09\u2028<br \/>\n\u8033\u3092\u5f15\u3063\u5f35\u308b\uff0f\u6ce3\u304f\uff0f\u4e0d\u6a5f\u5acc\uff0f\u5bdd\u3064\u304d\u304c\u60aa\u3044\uff0f\u6d3b\u52d5\u6027\u4f4e\u4e0b\uff0f\u98df\u6b32\u4f4e\u4e0b\uff0f\u71b1\u2028<br \/>\n\u5404\u9805\u76ee\u3000\u3044\u3064\u3082\u3068\u6bd4\u3079\u3066\uff08none \uff1a0\u70b9\u3000\/ a little\uff1a1\u70b9\u3000 \/ a lot\uff1a2\u70b9\uff09\u3067\u56de\u7b54\u3057\u5408\u8a08\u3059\u308b\u3002<\/p>\n<p>\u2028\u2028Primary Outcome\u2028<br \/>\n\u30fb\u75c7\u72b6\u304c\u307b\u307c\u6d88\u5931\u3059\u308b\uff08AOM-SOS\u30b9\u30b3\u30a2\u304c\uff10\uff5e\uff11\u70b9\u3068\u306a\u308b\uff09\u307e\u3067\u306e\u671f\u9593\u2028<br \/>\n\u30fb\u5404\u7fa4\u306eAOM-SOS\u30b9\u30b3\u30a2\u306e\u5e73\u5747\u5024\u306e\u6cbb\u7642\u958b\u59cb\u5f8c\uff17\u65e5\u9593\u306e\u63a8\u79fb<\/p>\n<p>\u2028\u2028Secondary Outcome\u2028<br \/>\n\u5168\u4f53\u7684\u306a\u52b9\u679c\u3001\u30a2\u30bb\u30c8\u30a2\u30df\u30ce\u30d5\u30a7\u30f3\u306e\u4f7f\u7528\u72b6\u6cc1\u3001\u6709\u5bb3\u4e8b\u8c61\u306e\u767a\u751f\u72b6\u6cc1\u3001\u9f3b\u54bd\u982d\u306e\u5e38\u5728\u5316\u7387<br \/>\n\u2028\u30d8\u30eb\u30b9\u30b1\u30a2\u8cc7\u6e90\u306e\u5229\u7528\u72b6\u6cc1<\/p>\n<p>\u3010\u7d50\u679c\u3011<br \/>\n\u2028\uff12\uff19\uff11\u540d\u304c\uff12\u7fa4\u306b\u5206\u3051\u3089\u308c\u3001ITT\u89e3\u6790\u304c\u884c\u308f\u308c\u305f\u3002<br \/>\n\u2028\u4e21\u7fa4\u306e\u60a3\u8005\u5c64\u306f\u540c\u7b49\u3067\u3042\u3063\u305f\u3002\u2028<br \/>\n\uff08\uff11\uff09\u75c7\u72b6\u304c\u307b\u307c\u6d88\u5931\u3059\u308b\uff08AOM-SOS\u30b9\u30b3\u30a2\u304c\uff10\uff5e\uff11\u70b9\u3068\u306a\u308b\uff09\u307e\u3067\u306e\u671f\u9593\u2028<br \/>\nABx\u7fa4<br \/>\n\uff12\u65e5\u76ee\u3000\uff12\uff10\uff05\u3000\u3000\uff14\u65e5\u76ee\u3000\uff14\uff11\uff05\u3000\u3000\uff17\u65e5\u76ee\u3000\uff16\uff17\uff05\u2028<br \/>\n\u30d7\u30e9\u30bb\u30dc\u6295\u4e0e\u7fa4<br \/>\n\u2028\uff12\u65e5\u76ee\u3000\uff11\uff14\uff05\u3000\u3000\uff14\u65e5\u76ee\u3000\uff13\uff16\uff05\u3000\u3000\uff17\u65e5\u76ee\u3000\uff15\uff13\uff05<br \/>\n\u2028\uff08\uff12\uff09\u5404\u7fa4\u306eAOM-SOS\u30b9\u30b3\u30a2\u306e\u5e73\u5747\u5024\u306e\u6cbb\u7642\u958b\u59cb\u5f8c\uff17\u65e5\u9593\u306e\u63a8\u79fb\u2028<br \/>\nABx\u7fa4\u304c\u6709\u610f\u306b\u4f4e\u304b\u3063\u305f\u3002\uff08\uff50\uff1d0.02\uff09\u2028<br \/>\n\u6cbb\u7642\u4fee\u4e86\u6642\u70b9\u306e\uff11\uff10\uff0d\uff11\uff12\u65e5\u76ee\u6642\u70b9\u3067\u3082\u30b9\u30b3\u30a2\u306f\u5e73\u57470.87\uff0895%CI\u30000.29\uff0d1.45\uff0cp=0.003\uff09\u3068\u6709\u610f\u306b\u4f4e\u304b\u3063\u305f\u3002\u2028<br \/>\n\uff08\uff13\uff09\u6cbb\u7642\u5931\u6557\u7387\u306fABx\u7fa4\u3067\u512a\u4f4d\u306b\u4f4e\u304b\u3063\u305f\u3002<br \/>\n\u6cbb\u7642\u9014\u4e2d\u306e4\uff0c5\u65e5\u76ee\u30004\uff05 vs 23%\uff08P<0.001\uff09\u2028\n\uff084\uff5e5\u65e5\u76ee\u306e\u5931\u6557\u306e\u5b9a\u7fa9\uff1a\u3000\u75c7\u72b6\u306e\u6539\u5584\u304c\u8a8d\u3081\u3089\u308c\u306a\u3044\u3001\u8033\u93e1\u6240\u898b\u304c\u60aa\u5316\uff09\n\u6cbb\u7642\u7d42\u4e86\u6642\u306e10\uff5e12\u65e5\u76ee\u300016\uff05 vs 51%\uff08P<0.001\uff09\u2028\n\uff0810\uff5e12\u65e5\u76ee\u306e\u5931\u6557\u306e\u5b9a\u7fa9\uff1a\u3000\u75c7\u72b6\u304c\u6d88\u5931\u3057\u3066\u3044\u306a\u3044\u3001\u8033\u93e1\u6240\u898b\u304c\u307b\u307c\u5b8c\u5168\u306b\u6cbb\u7652\u3057\u3066\u3044\u306a\u3044\uff09\n\u2028\u3000\u4e73\u69d8\u7a81\u8d77\u708e\u304c\u30d7\u30e9\u30bb\u30dc\u7fa4\u30671\u4f8b\u8a8d\u3081\u3089\u308c\u305f\u3002\n\u2028\uff08\uff14\uff0910\uff5e12\u65e5\u76ee\u306b\u304a\u3044\u3066\u3001\u4ee5\u4e0b\u306e\u5834\u5408\u306b\u6cbb\u7642\u6210\u7e3e\u304c\u6709\u610f\u306b\u60aa\u304b\u3063\u305f\u3002\n\u30fb\u9031\u306b10\u6642\u9593\u4ee5\u4e0a\u30013\u4eba\u4ee5\u4e0a\u306e\u5b50\u4f9b\u3068\u63a5\u89e6\u3057\u305f\uff08P=0.007\uff09\u2028\n\u30fb\u8a66\u9a13\u958b\u59cb\u6642\u306eAOM-SOS score\u304c\u60aa\u3044\uff088\u70b9\u4ee5\u4e0b\u30688\u70b9\u3088\u308a\u4e0a\u3067\u5206\u3051\u305f\u5834\u5408\uff09\uff08P=0.004\uff09\n\u30fb\u4e21\u5074\u306e\u4e2d\u8033\u708e\u306e\u5834\u5408\uff08P=0.002\uff09\u2028\n\u30fb\u9f13\u819c\u304c\u3088\u308a\u81a8\u9686\u3057\u3066\u3044\u308b\u5834\u5408\uff08P\uff1c0.001\uff09\n\u2028\uff08\uff15\uff0921\uff5e25\u65e5\u76ee\u306b\u304a\u3051\u308b\u518d\u71c3\u307e\u305f\u306f\u4e2d\u8033\u306e\u6ef2\u51fa\u6db2\u306e\u6301\u7d9a\u2028\u518d\u71c3\u2028\uff0810\uff5e12\u65e5\u76ee\u3067\u81e8\u5e8a\u7684\u306b\u6cbb\u7642\u304c\u6210\u529f\u3057\u305f\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u300121\uff5e25\u65e5\u76ee\u3067\u518d\u767a\u3057\u305f\u75c7\u4f8b\uff09\nABx\u7fa416\uff05\u3001\u30d7\u30e9\u30bb\u30dc\u7fa419\uff05\u3000\uff08P=0.56\uff09\u2028\n\u4e2d\u8033\u306b\u6ef2\u51fa\u6db2\u306e\u8caf\u7559\u2028\n\uff0810~12\u65e5\u76ee\u3067\u6cbb\u7642\u5931\u6557\u3068\u8a55\u4fa1\u3055\u308c\u305f\u60a3\u8005\u306b\u306famoxicillin-clavulanate\u306b\u52a0\u3048cefixime\u3092\u6295\u4e0e\u3055\u308c\u305f\uff09\u2028\u3000ABx\u7fa450\uff05\u3001\u30d7\u30e9\u30bb\u30dc\u7fa463\uff05\u3000\uff08P=0.05\uff09\u2028\n\uff08\uff16\uff09\u4e0b\u75e2\u3001\u30aa\u30e0\u30c4\u76ae\u819a\u708e\u306fABx\u6295\u4e0e\u7fa4\u3067\u591a\u304b\u3063\u305f\u3002\u2028\n\uff08\uff17\uff09\u4e21\u7fa4\u9593\u3067Streptococcus pneumoniae\u306e\u9f3b\u54bd\u982d\u306e\u5e38\u5728\u7387\u306b\u5909\u5316\u306f\u898b\u3089\u308c\u306a\u304b\u3063\u305f\u3002\n\n\u3010Conclusion\u3011\n\u2028\u6025\u6027\u4e2d\u8033\u708e\u3092\u3082\u3063\u305f\u751f\u5f8c6\uff5e23\u304b\u6708\u306e\u4e73\u5e7c\u5150\u306b\u5bfe\u3057\u3066\u306f\u300110\u65e5\u9593\u306e\u30a2\u30e2\u30ad\u30b7\u30b7\u30ea\u30f3\u30fb\u30af\u30e9\u30d6\u30e9\u30f3\u9178\u6295\u4e0e\u306f\u75c7\u72b6\u3092\u6539\u5584\u3059\u308b\u305f\u3081\u306e\u6642\u9593\u3092\u77ed\u7e2e\u3057\u3001\u75c7\u72b6\u3092\u8efd\u6e1b\u3057\u3001\u8033\u93e1\u691c\u67fb\u306e\u6025\u6027\u611f\u67d3\u5fb4\u5019\u306e\u6301\u7d9a\u7387\u3092\u6e1b\u3089\u3059\u3002\u2028\n\n\u2028\u3010\u8003\u5bdf\u3068\u30c7\u30a3\u30b9\u30ab\u30c3\u30b7\u30e7\u30f3\u3011\n\u5c0f\u5150\u306e\u4e2d\u8033\u708e\u3067\u6297\u751f\u5264\u6cbb\u7642\u306b\u60a9\u3080\u30b1\u30fc\u30b9\u306f\u6bd4\u8f03\u7684\u591a\u3044\u3002\u91cd\u75c7\u4f8b\u3067\u306f\u78ba\u304b\u306b\u6297\u751f\u5264\u6295\u4e0e\u3092\u7a4d\u6975\u7684\u306b\u8003\u3048\u308b\u304c\u3001\u8efd\u75c7\u304b\u3089\u4e2d\u7b49\u75c7\u306b\u95a2\u3057\u3066\u306f\u6297\u751f\u5264\u3092\u7528\u3044\u306a\u3044\u30b1\u30fc\u30b9\u3082\u3042\u3063\u305f\u3002\u2028\u78ba\u304b\u306b\u3001\u305d\u306e\u3088\u3046\u306a\u5834\u5408\u3001\u6570\u65e5\u5f8c\u306e\u518d\u8a3a\u306e\u969b\u306b\u6297\u751f\u5264\u3092\u958b\u59cb\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u30b1\u30fc\u30b9\u3092\u7d4c\u9a13\u3059\u308b\u3053\u3068\u3082\u5c11\u306a\u304f\u306a\u3044\u3002\u2028\u4eca\u56de\u306e\u7814\u7a76\u3067\u306f\u3001\u6cbb\u7642\u5931\u6557\u4f8b\u3068\u3057\u3066\u305d\u306e\u5272\u5408\u306a\u3069\u3092\u5177\u4f53\u7684\u306b\u660e\u8a18\u3057\u3066\u304f\u308c\u3066\u3044\u305f\u305f\u3081\u3001\u4eca\u307e\u3067\u306e\u81e8\u5e8a\u4e0a\u306e\u611f\u899a\u7684\u306a\u3082\u306e\u3092\u6570\u5024\u5316\u3057\u3066\u6349\u3048\u308b\u4e8b\u304c\u51fa\u6765\u305f\u3002\u2028\u3053\u306e\u8fba\u308a\u306e\u30c7\u30fc\u30bf\u3092\u63d0\u793a\u3059\u308b\u3053\u3068\u3067\u3001\u4eca\u5f8c\u306f\u7d50\u679c\u7684\u306b\u3069\u3061\u3089\u306e\u9078\u629e\u306b\u306a\u308d\u3046\u3068\u3082\u3001\u4eca\u307e\u3067\u3088\u308a\u3082\u591a\u3044\u60c5\u5831\u91cf\u306e\u4e2d\u3067\u5408\u610f\u3092\u5f97\u3064\u3064\u6cbb\u7642\u3057\u3066\u3044\u304f\u3053\u3068\u304c\u3067\u304d\u305d\u3046\u3067\u3042\u308b\u3002\u2028\u2028\n\n\u3010\u958b\u50ac\u65e5\u3011\n\uff12\uff10\uff11\uff11\u5e74\uff12\u6708\uff19\u65e5\uff08\u6c34\uff09 \n<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u3010\u6587\u732e\u540d\u3011 \u2028Alejandro,et al. Treatment of Acute Otitis Media in Children under 2 Years of Age. N Engl J Med 2011; 3 &hellip; <a href=\"https:\/\/www.hcfm.jp\/journal\/?p=660\" class=\"more-link\">\u7d9a\u304d\u3092\u8aad\u3080 <span class=\"screen-reader-text\">2\u6b73\u4ee5\u4e0b\u306e\u5b50\u4f9b\u306e\u6025\u6027\u4e2d\u8033\u708e\u6cbb\u7642\u306b\u5bfe\u3059\u308b\u6297\u83cc\u85ac\u306e\u4f7f\u7528<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[],"class_list":["post-660","post","type-post","status-publish","format-standard","hentry","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/660","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=660"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/660\/revisions"}],"predecessor-version":[{"id":661,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/660\/revisions\/661"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=660"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=660"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=660"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}