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Ear Infections: Skip The Antibiotics?

by The Kid's Doctor Staff

Researchers say the best treatment for many children with middle ear infections may be no treatment at all.

The analysis found antibiotics to be “modestly” more effective than just treating symptoms with pain medication. But use of antibiotics was also commonly associated with side effects like diarrhea and rash. Researchers say the review, published in the Journal of the American Medical Association, shows the merit of a watch-and-wait approach to managing ear infections.

Pros and Cons of Antibiotics

Current treatment guidelines give doctors the choice of prescribing antibiotics right away or observing children for up to three days with only pain management to see if they get better on their own.

The new analysis found that in most cases they do. Based on their review of more than 100 studies published over the last decade, the researchers were able to quantify the risks and benefits of treatment with antibiotics.

They estimated that for every 100 otherwise healthy children with uncomplicated middle ear infections, about 80 could be expected to improve without antibiotics within about three days. An additional 12 children could be expected to improve during this time if all were treated with antibiotics, but three to 10 would develop a treatment-related rash and five to 10 would get diarrhea.

“It is clear that the number of kids who would benefit from treatment with antibiotics is about the same as the number who develop treatment-related side effects,” says researcher Tumaini Coker.

“The Kid’s Doctor” pediatrician Sue Hubbard M.D., with Pediatric Associates of Dallas, likes the “watchful waiting” approach. She says it may be the better treatment for some ear infections.

“A new approach to treating ear infections in a child over 2, who is not ‘otitis prone’ and does not appear to be terribly sick is to treat the painful ear with pain relieving ear drops and oral Tylenol or Motrin. This is termed “watchful waiting”.

There have been several studies, in older children, to compare immediate versus delayed antibiotic treatment.  The studies to date have shown little difference in symptoms by watchful waiting and may indeed limit unnecessary antibiotics.  There is still the need for further research in this area, but I must say, I have used this approach in a lot of children.”

A prescription can be written for an antibiotic, but the physician may ask you to wait before filling it.

“I will write the antibiotic prescription as well as a pain relieving eardrop and instruct a parent to wait a few days before filling the antibiotic” says Hubbard. “If their child is improving they will not need to even take an antibiotic. I really have had a lot of success with this approach, but only in older children, who do not seem to be very ill.”

Brooklyn Otolaryngologist, Richard Rosenfeld, chairs the otolaryngology department at Brooklyn’s Long Island College Hospital. “I find that parents are delighted to avoid antibiotics when they can, because they are aware of the side effects,” he says. “Parents want their children to feel better and sleep through the night. For that you need ibuprofen, not antibiotics.”

The researchers also note that less treatment would result in big savings to the health care system. Antibiotics are prescribed more for ear infections than for any other childhood illness. A 2006 government survey found the average cost for treating ear infections to be $350 per child, totaling $2.8 billion a year.

When Antibiotics Are Needed

Not every child with an ear infection will get better without antibiotics. Rosenfeld says children who benefit most from treatment include:

•                Those with infections in both ears

•                Children with ruptured eardrums

•                Children who are 6 months old or younger

•                Those who have severe ear pain and/or high fever

The analysis was commissioned by the U.S. Agency for Healthcare Research and Quality to assist the American Academy of Pediatrics (AAP) in revising its existing treatment guidelines for middle ear infections.

If you believe your child’s ears are infected, you should let your pediatrician examine them for a correct diagnosis.

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