Patience Cuts Antibiotic Use for Ear Infections

Parents told to wait two days before filling prescription

TUESDAY, Sept. 2, 2003 (HealthDayNews) -- Asking parents to wait two days before filling a prescription for their child's ear infection is a safe way to significantly reduce the unnecessary use of antibiotics, new research suggests.

The study found that roughly two in three parents felt comfortable making antibiotics a "safety net" rather than a must. In most cases, the children got better on their own -- saving money and not contributing to the problem of drug-resistant bugs in the process.

Not giving antibiotics to a child with an ear infection "is a very reasonable thing to do," says study leader Dr. Robert M. Siegel, medical director of the Cincinnati Pediatric Research Group. At least two-thirds, and possibly as much as 90 percent, of ear infections clear up on their own within a day or two after symptoms appear. Antibiotics typically shorten the bout of the average ear infection by less than a day, Siegel says. Serious complications of the illness are rare.

Siegel's group report their findings in the September issue of Pediatrics. A second study in the journal found that total antibiotic use in children under 18 appears to be falling in this country. Much of the decline can be attributed to reduced antibiotic use in treating ear infections.

Those researchers saw a 24 percent drop in prescriptions per year among children under age 3, a 25 percent decline among those aged 3 to 6, and a 16 percent drop among older children. Nearly 60 percent of the decrease in the youngest age group involved changing treatment of ear infections, they say. Part of the drop also reflects fewer diagnoses of ear infections.

"The recent decline in antibiotic use is good news for children and for public health in the United States," Dr. Jonathan A. Finkelstein, a Harvard University pediatrician who led the second study.

In Europe, the convention is to wait out ear infections before prescribing antibiotics. But parents in the United States are much more insistent upon having the drugs. Ear infections are the single largest reason doctors prescribe antibiotics to children. They're also among the conditions most commonly over-treated with antibiotics -- a situation that has led to an alarming rise in drug-resistant germs in recent decades.

Unlike colds, which are viral and thus not responsive to the drugs, ear infections are typically cased by bacteria, and chiefly strains of germs called Pneumococcus. A decade ago, Siegel says, amoxicillin, the first line treatment, could kill off Pneumococcus at a reasonably low dose. Now, thanks to the over-prescribing of antibiotics, as many as a third of ear infections involving Pneumococcus strains require double doses or stronger drugs to be curbed.

European doctors have found antibiotic use in ear infections drops when they use a "safety net" approach -- offering parents painkillers for their children and giving antibiotics only after 48 hours of observation to see if the infection clears.

Siegel's group applied the same method in nearly 200 Midwestern boys and girls, whose average age was 5. Children were excluded from the study if they had a fever over 101.5 degrees Fahrenheit, if they'd had a recent ear infection or other signs of serious illness.

During the yearlong study, only 31 percent of parents reported filling the prescription. Nearly 80 percent said the pain medication -- acetaminophen, ibuprofen and ear drops -- helped. And 63 percent said they would be willing to use the same technique for future ear infections.

More information

For more on ear infections, check out the University of California at Davis or the National Institutes of Health.

SOURCES: Robert M. Siegel, M.D., medical director, Cincinnati Pediatric Research Group, Cincinnati; Jonathan A. Finkelstein, M.D., M.P.H., assistant professor, ambulatory care and prevention, Harvard Medical School, Boston; September 2003 Pediatrics
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