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Antibiotics Not So Effective for Children's Ear Infections


When children get an ear infection, the first thing many parents want is a prescription for antibiotics. However, a new study finds that antibiotics are only modestly more effective than no treatment at all, and that use of the drugs increases the risk of undesirable symptoms.

“Give my child antibiotics for his ear infection!”

The new study, which appears in the November 17 issue of the Journal of the American Medical Association, is an analysis of previous research regarding ear infections in children. Among the findings is one that otoscopic examinations (which allow clinicians to examine the interior of the ear) are a critical factor in acquiring an accurate diagnosis of acute otitis media (AOM), also known as middle ear infection.

In the United States, middle ear infections are the most common childhood infection for which physicians prescribe antibiotics. The authors report that 2006 data reveal an average of $350 per child was spent on such treatment. This information is important, as the authors also found that use of antibiotics is not much more effective than no treatment at all.

To arrive at their findings, Tumaini R. Coker, MD, MBA, of the David Geffen School of Medicine at UCLA, and RAND, Santa Monica, California, and colleagues, reviewed 135 previous relevant studies to support the American Academy of Pediatric’s new practice guidelines for middle ear infections, which are currently in preparation.

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The authors found that “perhaps the most important way to improve diagnosis is to increase clinicians’ ability to recognize and rely on key otoscopic findings,” and that redness and a bulging tympanic membrane found on such examinations were associated with an accurate diagnosis.

Regarding antibiotic use, when the authors considered 100 children at average risk for middle ear infections, they noted that “approximately 80 would likely get better within about 3 days without antibiotics.” The authors also found that most antibiotics used to treat uncomplicated ear infections in children are similarly effective, and no evidence that any antibiotic was superior to amoxicillin.

If all the children were treated immediately with ampicillin or amoxicillin, an additional 12 children would probably improve, but then there would be the risk of side effects related to the antibiotics. Specifically 3 to 10 children would develop a rash and 5 to 10 children would develop diarrhea.

One of the best ways to help prevent ear infections is for children to get the pneumococcal conjugate vaccine (PCV). There are now two such vaccines: the previous 7-valent vaccine and the newer 13-valent vaccine. The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. The Centers for Disease Control and Prevention recommends that children younger than age 2 years be vaccinated, starting at 2 months of age. Studies show that vaccinated children get many fewer ear infections than children who have not been vaccinated.

The authors concluded that while they uncovered evidence that can help physicians with the diagnosis and management of ear infections in children, including the use of antibiotics, more research is needed in several areas, including surveillance of agents that cause middle ear infections, especially in view of the new PCV13 vaccine.

Coker TR et al. Journal of the American Medical Association 2010; 304(19): 2161-69
National Institute on Deafness and Other Communication Disorders