Childhood Ear Infections: Wait, Don’t Treat

Healthnotes Newswire (October 26, 2006)—It may be the most difficult thing parents can do: withhold treatment while their child suffers. But this approach may be just what the doctor orders the next time your child comes down with a middle ear infection (otitis media). New research published in the Journal of the American Medical Association shows that nonaction is often the right course of action.

“Otitis media has a high rate of spontaneous resolution whether antibiotics are prescribed or withheld,” said the study’s lead author, David M. Spiro, MD, MPH Director of Pediatric Emergency Medicine, Doernbecher Children’s Hospital, Oregon Health & Science University. “The rate of complications is similar whether or not antibiotics are given. Meanwhile, resistance to antibiotics is a major public health problem. Our approach substantially reduced unnecessary use of antibiotics in children with acute otitis media, with similar outcomes.”

Spiro and colleagues at Yale University School of Medicine studied 283 children, ages 6 months to 12 years, who came to the emergency department for ear infection treatment. The children were randomly assigned to one of two groups. One group was given a standard prescription for an antibiotic and told to fill it right away. The other group was given a prescription for an antibiotic and told to wait and see. Those who received the wait-and-see prescription were told not to fill the prescription for 48 hours unless the child was either not feeling better or feeling worse. All of the children were given medication for ear pain.

The researchers found that two-thirds of the parents in the wait-and-see group did not fill the prescription, and their children got better at the same rate as children whose parents filled the prescription. The rates of fever, ear pain, and return visits for medical care were no different between the two groups.

Acute otitis media is the most common reason antibiotics are prescribed to children. Many disease-causing bacteria that once responded to antibiotics have become resistant to drug therapy and are becoming a serious public health threat. Tuberculosis, gonorrhea, malaria, and childhood ear infections are among the many diseases that have become hard to treat with antibiotics. When antibiotics are used inappropriately (for example, for viral infections) or ineffectively (for example, the complete regimen is not followed), bacteria can become resistant to the drugs. Later, infections caused by these resistant microbes must be treated with experimental and potentially toxic drugs. In an effort to stem this potentially disastrous trend, some forward-thinking countries, such as Germany, even levy a fine on doctors who inappropriately prescribe antibiotics.

“Most pediatricians have been trained to routinely prescribe antibiotics for ear infections and believe many parents expect a prescription,” said Dr. Spiro. “We found taking a wait-and-see approach is as safe, effective, and quick as antibiotics in resolving most childhood ear infections.”

(JAMA 2006;296:1235–41)

Jeremy Appleton, ND, CNS, is a licensed naturopathic physician, certified nutrition specialist, and published author. Dr. Appleton was the Nutrition Department Chair at the National College of Naturopathic Medicine, has served on the faculty at Bastyr University of Natural Health Sciences, and is a former Healthnotes Senior Science Editor and a founding contributor to Healthnotes Newswire. He has worked extensively in scientific and regulatory affairs in the supplement industry and is now a consultant through his company Praxis Natural Products Consulting and Wellness Services.

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