Wait-and-See Approach Works for Children's Ear Infections

Even those seen at the ER don't necessarily need antibiotics, study finds

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By Serena Gordon
HealthDay Reporter

TUESDAY, Sept. 12, 2006 (HealthDay News) -- Children with acute ear infections may not need antibiotics to get better, even when the infection is severe enough to prompt a visit to the emergency room.

A new study found that almost two-thirds of children given a prescription for antibiotics -- just in case -- didn't need to have the prescription filled to get better.

"Our study evaluated a 'wait-and-see' prescription for ear infections in children," said the study's lead author, Dr. David Spiro, who was at Yale University School of Medicine at the time of the study. "Compared to children who were given antibiotics, children in the wait-and-see group had the same outcomes."

Spiro, who now heads Pediatric Emergency Medicine at Doernbecher Children's Hospital and Oregon Health and Science University in Portland, said that by giving parents a prescription and asking them not to fill the prescription unless the child developed a higher fever or had continued ear pain, doctors can empower families to become part of the child's health-care team.

Additionally, he said, by offering the wait-and-see prescriptions, doctors can help families save time and money. That's because if the child's condition worsens, parents don't have to take time off from work to go see the doctor again if they already have a prescription in hand.

The study findings are published in the Sept. 13 issue of the Journal of the American Medical Association.

Each year, about 15 million antibiotic prescriptions are filled to treat acute ear infections -- called acute otitis media by doctors. There are several reasons why doctors would like to see this number go down.

The first is that acute otitis media often gets better on its own, with no treatment. That means children may be unnecessarily exposed to antibiotic side effects. The second reason is that there's growing concern about antibiotic resistance, and if antibiotics are given to children who really don't need them, this will just contribute to the problem.

Previous studies have looked at children who don't have severe otitis media, and those studies found that children often get better without antibiotic treatment. The new study's goal was to look at a sicker group of children and see if they could wait to take antibiotics without developing complications.

Spiro and his colleagues recruited 283 children between the ages of 6 months and 12 years old who were seen in the emergency room because of an acute ear infection. All of the children were given ibuprofen and pain-relieving ear drops.

One hundred and forty-five children were randomly selected for the standard prescription group; they were given a prescription for antibiotics and told to fill it. And there were 138 children in the "wait-and-see" group. In this group, parents were still given a prescription, but they were asked to wait to fill it. The parents in this group were told to fill the prescription only if the child hadn't shown signs of improvement or had worsened in the 48 hours following their emergency-room visit.

In the standard prescription group, 87 percent of parents filled their child's prescriptions, while only 38 percent of the parents in the wait-and-see group ended up doing so. There were no statistically significant differences in the rates of fever, ear pain, and additional medical visits between the two groups.

The most common reasons that parents in the wait-and-see group ended up filling the prescriptions were fever and ear pain.

"If your child has an uncomplicated ear infection, ask your doctor if they can give you a wait-and-see prescription," Spiro suggested.

Dr. Irwin Benuck, attending pediatrician at Children's Memorial Hospital in Chicago and professor of clinical pediatrics at Northwestern University, said parents, especially younger parents, are getting the message that antibiotics aren't always the answer for every illness.

"Pediatricians are trying as hard as they can not to prescribe antibiotics unless they're necessary," he said.

Benuck said the new study confirms that antibiotics aren't needed for most ear infections, though he noted that he would have preferred if the researchers had been able to recheck the children's ears rather than rely on the parents' report that the child was better.

Spiro said there are some children who shouldn't be given a wait-and-see prescription. They include babies under 6 months of age, children with chronic ear infections, and children who appear seriously ill.

More information

To learn more about acute ear infections, read this information from the National Library of Medicine.

SOURCES: David M. Spiro, M.D., M.P.H., director, pediatric emergency medicine, Doernbecher Children's Hospital, Oregon Health and Science University, Portland; Irwin Benuck, M.D., attending pediatrician, Children's Memorial Hospital, and professor of clinical pediatrics, Northwestern University, Chicago; Sept. 13, 2006, Journal of the American Medical Association

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