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Antibiotics Only Help With Some Ear Infections

Those under 2 with otitis media in both ears most likely to benefit, study finds

FRIDAY, Oct. 20, 2006 (HealthDay News) -- Doctors often prescribe antibiotics for ear infections in children, but a new study suggests only the very youngest and sickest reap any benefits from the treatment.

According to a team of Dutch researchers, children under the age of 2 who have infections in both ears are helped by antibiotics. For most children, however, the condition simply resolves itself.

The report appears in the Oct. 21 issue of The Lancet.

The condition known as otitis media occurs when the middle ear, behind the eardrum, becomes infected. One of the most common childhood infections, the condition causes pain and fever.

In the study, Dr. Maroeska Rovers, from the University Medical Center Utrecht, and colleagues collected data on six studies that included a total of 1,643 children.

Rovers' team found the benefit of antibiotics for pain and fever was dependent on the child's age, extent of the infection, and also the presence of otorrhoea (discharge from the ear). The greatest benefit was seen in children under 2 who had infection in both ears.

For older children, the use of antibiotics was usually no more effective than waiting for the condition to get better by itself. However, antibiotics did help children with otorrhoea, irrespective of age, they added.

"We conclude that antibiotics are beneficial in relieving residual pain or fever at three to seven days in children younger than 2 years of age with bilateral acute otitis media, and in children with acute otitis media and otorrhoea," the researchers wrote. "For most other children with mild disease, an observational policy seems justified."

Experts agreed that antibiotics are not needed in most cases.

"This finding supports the position of the American Academy of Pediatrics and American Academy of Family Physicians," said Dr. Allan Lieberthal, a pediatrician at Kaiser Permanente and co-chairman of the American Academy of Pediatrics and American Academy of Family Physicians' subcommittee on the management of acute otitis media.

"Observation, without antibiotics, is a valid option for the management of most children with ear infections," Lieberthal said. However, he added that children need to be assessed individually and those with high fever and a lot of pain may need antibiotics.

Part of the reason that antibiotics are in disfavor for treating most ear infection is the fear of the overuse of the drugs, which has led to a proliferation of antibiotic-resistant bacteria.

"What has been shown over and over again is that the resistant rate of common bacteria in countries that universally prescribe antibiotics for ear infection, such as the United States up to about two years ago, is much higher than in countries that don't routinely prescribe antibiotics," Lieberthal said.

"We are in the age where delayed treatment is a very smart option," said Dr. David M. Spiro, director of pediatric emergency medicine at Doernbecher Children's Hospital, a part of the Oregon Health and Science University. "We are not in an age where we need to immediately prescribe antibiotics for every single patient with acute otitis media."

Patients with high fever or who have underlying medical problems should always be given antibiotics, Spiro said. "But the vast majority of children with ear infections don't look ill, many of them don't have a fever, and many of them don't have otitis media," he said.

However, whether antibiotics are given or not, the pain associated with an ear infection should be treated aggressively, he noted.

More information

The U.S. National Institute on Deafness and Other Communication Disorders can tell you more about ear infections.

SOURCES: Allan Lieberthal, M.D., pediatrician, Kaiser Permanente, Panorama City, Calif., co-chair. American Academy of Pediatrics and American Academy of Family Physicians' subcommittee on the management of acute otitis media; David M. Spiro, M.D., M.P.H., director, pediatric emergency medicine, Doernbecher Children's Hospital, Oregon Health and Science University, Portland; Oct. 21, 2006, The Lancet

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