Nov. 16, 2010 -- The best treatment for many children with middle ear infections may be no treatment at all, a review of the research confirms.
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.
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,” researcher Tumaini Coker tells WebMD.
Parents OK With No Treatment
A pediatrician with Mattel Children’s Hospital UCLA and a researcher with the nonprofit research group RAND Corporation, Coker says in her experience most parents are willing to try the watch-and-wait approach if their child’s pain is adequately managed.
Brooklyn otolaryngologist Richard Rosenfeld tells WebMD he often gives parents a "safety net" antibiotic prescription to be filled only if the child gets worse or does not improve within a few days.