Antibiotics for toddler ear infections may trump watchfulness

Kathleen Blanchard's picture
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Waiting to give antibiotics to toddlers for ear infection may not always be the best practice, suggests research.

Kids who frequently develop infections in the middle ear, or acute otitis media, were found to get better quicker and experience less severe symptoms compared to a group given placebo, according to a study published in the New England Journal of Medicine.

Children randomized in the study to receive either amoxicillin-clavulanate or a placebo for 10 days were observed for reduction in both the severity and duration of symptoms. Compared to the placebo group, the children, between 6 and 23 months of age, responded more quickly and avoided complications that can accompany ear infections.

Researchers at the Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center conducted the study to clarify confusion about the usefulness of antibiotics for treating ear infections that generally get better over time.

Past findings have been conflicting due to lack of stringent criteria about the definition of middle ear infection between studies.

For the current investigation, the researchers used strict guidelines for determining diagnosis of acute otitis media, studying 291 children.

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Alejandro Hoberman, MD, of Children's Hospital of Pittsburgh conducted the study that found the practice of watchful waiting that is common in Canada and many European nations may not always be best for children with ear infections. In the US, physicians are more inclined to withold antibiotics if diagnosis of otitis media is uncertain.

Concerns over antibiotic resistance contribute to current clinical practice of waiting to see if children get better before giving antibiotics. In the study, 23% of the children in the placebo group failed to get better or had worsening symptoms, compared to just 4% of the children treated with antibiotics.

Antibiotics have side effects that the researchers say should still be considered, as well as the issue of drug resistance. In the study, half of the children given treatment developed diarrhea and diaper rash, but were less likely to have complications from ruptured eardrum.

Within 2 days, 35% were completely better, 61% within 4 days and by day 7, 80% of the children's otitis media had resolved. In the placebo group, 28% had initial resolution of symptoms by day 2, 54% by day 4, and 74% at day 7.

The new study shows children who promptly received antibiotic for definite ear infection, known as acutes otitis media, recovered more quickly, had less severe symptoms and complications from ruptured eardrum, compared to those given placebo.

NEJM

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