Over the last few years a strong debate over the use of antiobiotics as a first line of treatment for acute otitis media, or ear infections, in children has developed. Many opponents argue that ear infections would resolve on their own if left untreated for 48-72 hours and that antibiotics do not provide any significantly more rapid recovery. As well the overwhelming use of antibiotics in children with recurrent otitis media has bred strains of resistant bacteria which further complicate the debate.
More recently the American Academy of Pediatrics and many family practitioners have adopted a wait and see policy when it comes to ear infections. When a child is initially diagnosed with an ear infection, they are given symptomatic treatment with pain relievers and fever reducers, but parents are not encouraged to go and fill the antibiotic prescription until it has been at least 2 days, but more likely 3 days. This wait and see policy was aimed at reducing the unnecessary use of antibiotics and therefore the creation of resistant strains of bacteria.
Most ear infections will resolve in 2-3 days left untreated. Most are also caused by viral illnesses, which are not cured by antibiotics, even though antibiotics may relieve some symptoms. And the most bothersome symptoms of an ear infection are the pain (otalgia) and fever, both of which antibiotics do not treat.
This month in the Journal of American Medical Association one of the first studies to follow-up on the wait and see policy was published. In the study more than 280 cases of otitis media that presented in an emergency room were randomized to either the wait and see policy or an immediate antibiotic prescription.
Then outcomes such as duration of infection, fever, pain, follow-up doctors visits, and filled prescriptions were assessed in each child over the next 40 days.
From the total 283 patients, 138 were in the wait and see group and 145 were instructed to fill prescription right away. Only 38% of patients in the wait and see group filled their prescription compared to 67% in the other group.
There were no significant clinical differences between the groups, including symptoms such as fever, ear pain, and follow-up visits. However, in the wait and see group filling the prescription was associated with an increase in fever and ear pain.
The authors concluded that the wait and see policy resulted in significantly less antibiotics used to treat ear infections with no difference in clinical outcome. It is a viable alternative to the standard antibiotic prescription given in the emergency room setting.
Posted by Dr. Christina Gutierrez on September 28, 2006 03:01 PM
