Cutting Antibiotics for Ear Infections

Most Disappear on Their Own if Parents Can Wait, Study Shows

Medically Reviewed by Louise Chang, MD on September 12, 2006

Sept. 12, 2006 -- Most children with ear infections do not need antibiotics, but they get them anyway. Now, a new study suggests parents are often willing to delay treatment if they know their kids can get the drugs if they need them.

Giving parents the option of delaying treatment meant far fewer kids ended up taking antibiotics -- with no significant increase in complications, researchers reported in the Sept. 13 issue of JAMA, The Journal of the American Medical Association.

In the study, almost two-thirds of the antibiotic prescriptions written to parents urged to delay treatment never got filled.

Meanwhile, roughly nine of 10 children whose parents were not given the special instruction to "wait-and-see" ended up taking antibiotics.

15 Million Ear Infection Prescriptions

Ear infections are the most common reason for antibiotic use among U.S. children, with 15 million prescriptions written annually.

Antibiotic resistance is a growing worldwide public health concern that has been spurred by the widespread overuse of the drugs.

"In this country, 96% to 98% of physicians treat ear infections immediately with antibiotics, even though most cases will resolve on their own without treatment," David M. Spiro, MD, MPH, tells WebMD.

Spiro and colleagues from Yale and Vanderbilt University conducted their study to determine if parents would accept a "wait-and-see prescription" approach to antibiotic treatment when their children had ear infections, and whether the approach would reduce antibiotic use.

The study included 283 children between the ages of 6 months and 12 years with ear infections treated at an urban hospital emergency department.

Children were not included in the study if they had another infection such as pneumoniapneumonia, were severely ill from the ear infection, were hospitalized, had ear tubes or a ruptured ear drum, or had received antibiotics within the prior week.

Roughly half the studied children received prescriptions for antibiotics with no special instructions.

The other half also received prescriptions, but parents were asked not to fill them unless the child was either "not better, or worse" after 48 hours.

All the children were given free bottles of ear drops for pain and liquid ibuprofen, which was a very important part of treatment, Spiro says.

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."

Show Sources

SOURCES: Spiro, D. JAMA, The Journal of the American Medical Association, Sept. 13, 2006; vol 296: pp 1235-1241. David M. Spiro, MD, MPH, Oregon Health and Science University, Portland. Ore. Richard Rosenfeld, MD, director, pediatric otolaryngology, Long Island College Hospital, Brooklyn, N.Y. Paul Little, MD, MBBS, Community Clinical Sciences Division, University of Southampton, Southampton, U.K. News Release, American Academy of Pediatrics.

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