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Kids' Ear Infections: Antibiotics vs. Waiting

Less Aggressive Treatment for Otitis Media Gains Ground With Parents and Doctors

Immediate Antibiotics vs. Watchful Waiting continued...

Half of the kids got antibiotics --10 days of twice-a-day amoxicillin. The other half were sent home, and their parents were told to wait to see if their children got better. If they didn't, they came back for antibiotic treatment.

In the first 12 days, the children in the treatment group tended to get over their symptoms more quickly. They needed fewer doses of pain medication. However, these kids were also more likely to harbor drug-resistant germs. And early treatment did not keep some of these kids from having recurrent otitis media within 30 days.

By day 30, the cure rate in both groups was almost identical: 77% in the immediate treatment group and 76% in the wait-and-watch group. Parents were equally satisfied with each form of treatment at both 12 and 30 days.

Importantly, 66% of watch-and-wait kids did not need antibiotic treatment.

The researchers identified key factors to making the watch-and-wait strategy work:

  • Doctors must assess otitis media severity.
  • Doctors must educate parents about the risks of untreated otitis media and the risks of overprescribing antibiotics.
  • Otitis media symptoms should be managed.
  • Parents must have access to follow-up care.
  • Effective antibiotics must be available when needed.

Watchful Waiting: Who Would Do It?

Is watchful waiting ready for U.S. prime time? Harvard researcher Jonathan Finkelstein, MD, MPH, and colleagues note that some experts don't think it's a good idea, despite the new treatment guidelines.

To see whether watching and waiting might really work for U.S. kids with otitis media, Finkelstein's team asked more than 2,000 parents and 160 doctors what they thought about holding off antibiotic treatment. Their findings:

  • 38% of parents say they'd be satisfied or extremely satisfied with watchful waiting.
  • 40% of parents say they'd be unsatisfied or extremely unsatisfied with watchful waiting.
  • 38% of doctors say they never or almost never try watchful waiting.
  • 39% of doctors say they "occasionally" try watchful waiting.
  • 17% of doctors say they "sometimes'' try watchful waiting.
  • 6% of doctors say they recommend watchful waiting most of the time.

For parents, the results are clear.

"Parental opinions in a community are likely to change as experience with successful treatment of acute otitis media without antibiotics becomes more common," Finkelstein and colleagues write.

For doctors, it's not so clear. While there are community-wide benefits such as a reduction in antibiotic resistance, watchful waiting isn't a very great benefit to an individual patient. Some experts don't think it's a good idea at all. And U.S. doctors tend to prefer active treatment over passive waiting.

"For all these reasons, one would predict that the practice of [watchful waiting for nonacute otitis media] will follow a slow adoption curve," the researchers suggest.

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