Kids' Ear Infections: Antibiotics vs. Waiting

June 6, 2005 -- U.S. doctors usually treat kids' middle ear infections -- otitis media -- with antibiotics. That may be changing, new studies show

The first study, a clinical trial, shows that immediate antibiotic treatment results in fewer symptoms in the first 10 days. But simply watching and waiting to see if the infection gets worse worked too -- and it cut antibiotic use by two-thirds. Thirty days after the first doctor visit, the cure rate was the same in the immediate treatment and watchful-waiting groups.

The second study surveyed parents and doctors in six Massachusetts communities. About a third of parents said they'd be satisfied with their kids' otitis media treatment if their doctors advised watching and waiting. But 40% said this would not be satisfactory. Meanwhile, 38% of doctors said they never used watching and waiting for otitis media. Only 6% said they did it most of the time, while 39% reported occasional use.

Both studies appear in the June issue of Pediatrics.

Can Ear Infections Just Go Away?

Most of the time, otitis media clears up all by itself. But it has to be watched very carefully. That's because otitis media is caused by fluid that builds up in a child's middle ear. That fluid gives germs -- bacteria -- a chance to grow in a dangerous place.

Standard treatment in the U.S. is to give children antibiotic treatment right away. It almost always seems to work, because kids' ears clear up. But this often happens without treatment too. In fact, two-thirds of the kids in the Pediatrics study got better without antibiotics.

Doctors and parents worry about simple earaches becoming more serious infections. That's why so many prefer early treatment. There is, however, a downside. Sixty percent of childhood antibiotic prescriptions are for otitis media. Such massive antibiotic use is leading to a germ counterattack. The bad bugs are becoming resistant to antibiotics. This means that in the future, effective treatment is going to be more difficult, and more expensive.

Can doctors really cut back on antibiotic treatment for otitis media? The American Academy of Pediatrics and the American Academy of Family Physicians have already taken a first step. Last year, they published treatment guidelines giving doctors the option of watching and waiting for nonsevere cases of otitis media -- only mild ear pain and no high fever -- in kids 2 years of age and older.

But does watching and waiting really work? And even if it does would parents and doctors really accept a strategy of watching and waiting to see if the ear infection gets better on its own?

Immediate Antibiotics vs. Watchful Waiting

David McCormick, MD, of the University of Texas Medical Branch, Galveston, led a study of 223 kids aged 6 months to 12 years with nonsevere otitis media. The kids had symptoms of a middle ear infection, had fluid in their ear but did not have a serious infection.