Cutting Antibiotics for Ear Infections
Most Disappear on Their Own if Parents Can Wait, Study Shows
Analgesics, Not Antibiotics
Pediatric ear, nose, and throat specialist Richard Rosenfeld, MD, tells
WebMD parents often give antibiotics more credit for making their child feel
better than they deserve.
"If you want your child to feel better and sleep through the night, the
answer is not antibiotics; it is analgesics," he says. Analgesics are
Well over half the parents advised to delay antibiotic treatment (62%) ended
up not getting their child's prescription filled, compared with just 13% of
parents who were not given the special instructions.
Some reasons parents in the wait-and-see group did fill the prescriptions
were fever (60%), ear pain (34%), and fussy behavior (6%).
Ear pain did resolve, on average, a half day earlier in the
immediate-treatment group. But those children also had more symptoms related to
antibiotic use, including diarrheadiarrhea and vomiting. Almost one of four children
in the group that took more antibiotics (23%) experienced diarrhea, compared
with 8% of those in the group that took fewer antibiotics.
"There is no free lunch," Rosenfeld says. "As payback for that half a day
less of ear pain you get more diarrhea and more vomiting."
80% Don't Need Antibiotics
The idea of delaying antibiotic treatment for ear infections is not new. The
strategy is catching on in Europe, and the American Academy of Pediatrics says
80% of children whose ear infections are not treated immediately with
antibiotics get better on their own.
The AAP gave its stamp of approval to the watch-and-wait strategy in 2004,
telling physicians it was OK to delay antibiotics in children over age 2 for 48
to 72 hours as long as pain is managed with pain relievers like ibuprofen or
But the strategy will not work, Rosenfeld says, unless parents are given
enough information to make them comfortable with the idea.
Specifically, they need to understand that for many children the benefits of
taking antibiotics for ear infections are outweighed by the side effects, which
can include diarrhea, upset stomach, rash, allergiesallergies, and the possibility of drug
"We need to replace antibiotic therapy with information therapy. You can't
just replace antibiotics with nothing," he says. "Parents won't stand for
Paul Little, MD, conducted one of the first studies examining the delayed
antibiotic approach to treatment of ear infections in the United Kingdom. He
agrees informed parents will accept the idea of delaying antibiotics for ear
"If parents are used to giving their children antibiotics for ear
infections, and that is what everyone else is doing, it may be a bit of a
struggle," he says. "But when they understand the issue, they are more