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    Early Antibiotics Help Ear Infections in Young Children

    Study Leaders Predict Changes in the Current Watch-and-Wait Approach


    In the Finnish study, Paula A. Tahtinen, MD, and colleagues at Turku University studied 319 children aged 6 to 35 months with acute otitis media. Half were treated with a seven-day course of Augmentin, a powerful antibiotic. The other half were given inactive placebos.

    Only 18.6% of the children treated with antibiotics got worse or failed to improve, compared with 44.9% of the children in the placebo group. However, nearly half the children treated with antibiotics had diarrhea, compared to only about a quarter of the kids in the placebo group.

    Hoberman's University of Pittsburgh team studied 291 children aged 6 to 23 months with acute otitis media. Again, half were treated with Augmentin for seven days, while half received a placebo.

    Four or five days after Augmentin treatment, only 4% of kids got worse or failed to improve -- nearly six times better than the 23% of kids who got worse or no better on placebo.

    Children who got the antibiotics were much more likely to get diarrhea and diaper rash. But they also were far less likely to suffer severe complications, such as a perforated eardrum.

    So will doctors start using antibiotics willy-nilly? No, Hoberman and Klein suggest.

    "Our study underscores the need to treat only kids who meet stringent criteria for a diagnosis of otitis media," Hoberman says. "lf that is the case, we won't have to treat half the kids now getting antibiotics for uncertain ear infection. The idea is to stick with the ones that have strictly defined otitis media."

    And that shouldn't be too hard, Klein says. Although he notes that it's hard to look into the ear of a screaming, squirming infant, it's nothing a pediatrician doesn't do every day.

    "Let's say a pediatrician sees just 10 ill children a day: That's 20 ears a day or about 5,000 ears a year. So most pediatricians are very good at otoscopic diagnosis," Klein says.

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