Another study on antibiotics for ear infections

The medical profession — and parents — should already be convinced that antibiotics are not recommended for children's ear infections. Numerous studies have conclusively shown that beyond a doubt. Still, many parents leave an M.D.'s office with a prescription for the useless and often harmful drug.

Now, yet another study has added even more evidence that antibiotics are not helpful for ear infections in children and are over-prescribed for the common childhood illness.

"Many parents expect an antibiotic will be prescribed for a child with an ear infection. Usually they do not come into a doctor's office and ask for an antibiotic, but there is a physician perception that parents expect to get one. This unspoken pressure to prescribe is considered a major factor in the potential overuse of antibiotics," stated investigator Paul S. Matz, M.D.

Overuse of antibiotics is cited as a significant reason for the increasing resistance worldwide among many bacterial strains, he said.

"We can tell parents that their children don't need antibiotics all the time for ear infections," said Dr. Matz, a research fellow in the Department of Pediatrics at the Brown Medical School. "In selected cases, use of ear drops may prevent over prescription of antibiotics, while satisfying parental desires for treatment."

Typically, simple pain relief will make a childhood ear infection better, Matz said. In fact, standard care for ear infections, known medically as acute otitis media, includes use of pain relief medications such as acetaminophen, he said.

"At least half of ear infections will go away on their own," Matz said. "The pain usually lasts 12 to 24 hours. Knowing that antibiotics don't add anything, parents may wait 48 hours, while their child receives safe pain relief."

The study involved 88 children, between 2 and 18 years of age, seen in an urgent-care clinic and diagnosed with ear infections.

Forty-two were randomized to receive ear drops which helped reduce the pain symptoms, the other 46, an oral antibiotic.

All families completed a symptom diary, including a standardized pain scale. Children were reevaluated after 2 to 7 days, with parents asked whether they were satisfied with treatment.

Matz and colleagues found that 89% of children who didn't receive the antibiotics got better — compared with 95% of children who received antibiotics.

"The 89 percent of children who got better with ear drops were spared antibiotics that would have been given by the standard of care," Matz said.

Matz presented the findings at the 2001 Pediatric Academic Societies meeting in Baltimore. He is based in the Division of Ambulatory Pediatrics in Rhode Island Hospital.

There is a suspected link between overuse of antibiotics to treat ear infections and the explosion of bacterial resistance, he said. In fact, there is growing resistance to the commonly prescribed amoxicillin among several bacterial strains that infect ears.

"Some bacteria that cause ear infections can also cause sepsis, pneumonia and meningitis. If they do cause one of these more serious illnesses and the bacteria has developed resistance to antibiotics, then we may have great difficulty treating that child," Matz said.

SOURCE: "Ear Drops' Effect on Antibiotic Treatment of Ear Infections," Pediatric Academic Societies, May 1, 2001.

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