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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 pain-relieving drugs.

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 acetaminophen.

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 resistance.

"We need to replace antibiotic therapy with information therapy. You can't just replace antibiotics with nothing," he says. "Parents won't stand for it."

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 infections.

"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 accepting."

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