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February 2011

Study finds antibiotics may not be the best treatment for childhood ear infections

A study published in the Nov. 17, 2010 edition of the Journal of the American Medical Association revealed that the use of antibiotics to treat newly diagnosed acute ear infections in children is only slightly more effective than doing nothing at all.

What the news means to you

Antibiotic risks, benefits,
must be weighed in each case of ear infection.

David E.
Karas, MD

Learn more

Researchers from Mattel Children's Hospital UCLA in Los Angeles conducted the study designed to help experts update treatment guidelines for common ailments, which are soon to be released by the American Academy of Pediatrics. Childhood ear infections are among the most common childhood illnesses in the United States.

Results of the study showed that 80 out of 100 children, if given only medication to reduce pain or fever, would recover from an acute ear infection within a few days. The research findings also showed that name-brand antibiotics are no more effective than generic antibiotics. According to the clinical investigators, despite these findings, the higher-priced antibiotics are often prescribed for uncomplicated acute ear infections.

"Our findings reinforce the existing knowledge that the best antibiotic treatment for common childhood ear infections may be no antibiotic treatment at all," said Tumaini R. Coker, MD, a pediatrician at Mattel Children's Hospital UCLA and the lead author of the study. "Prescribing antibiotics early may help cure ear infections a little bit faster, but also raises the risk that children will suffer antibiotic-related side effects such as a rash or diarrhea."

Dr. Coker also noted that over-the-counter medications, like Tylenol or Motrin, relieve pain and sleeplessness, symptoms antibiotics don't help for days.

What the news means to you

The findings in this study by Coker, et al., reinforce what clinicians have known for quite some time: that 80 percent of patients will get better with over-the-counter pain and fever relief; only about 1 in 7 patients treated with antibiotics for ear infection will recover quickly.

Needless to say, an accurate diagnosis begins with a visit to your pediatrician or primary caregiver. Once a diagnosis has been made, antibiotics may be prescribed to treat an acute ear infection, also known as otitis media. Amoxicillin remains the mainstay for initial treatment therapy — for its effectiveness, cost and generic availability. However, antibiotics should be reserved for those patients with true infection and who are not improving on their own.

Does this new analysis provide pediatricians and primary caregivers with better guidelines in the treatment of ear infections? While this article gives no direct answer, it indicates that the decision to treat should be weighed against the risks of antibiotic use, which includes but is not limited to rash and diarrhea. There are a host of side effects specific to each individual antibiotic that were not addressed by these studies; and the longer-term issue of antibiotic resistance is also a concern.

Acute ear infection is an extremely common ailment, and it is the second most common diagnosis among all age groups in the United States. Studies show that 17 to 29 percent of infants will experience at least one ear infection; and 10 percent of infants will experience three or more episodes. By the age of six, 75 percent of children will have had at least one ear infection.

The pneumococcal conjugate vaccine (PCV), which first became available in 2000, has been recommended for all children beginning at 2 months of age. Some studies indicate that children who have been given PCV are less likely to develop ear infections, and ultimately, less likely to need an ear tube placement. However, some patients, despite adequate treatment and PCV immunization, will experience chronic ear infections and require ear tubes. The placement of ear tubes is the most common surgical procedure in the United States and almost always results in immediate improvement/cure.

At Yale-New Haven Children's Hospital, we have the ability to accurately confirm persistent ear infection problems with the use of an otomicroscopy, an ear microscope. In addition, we offer comprehensive management of infants and children with all types of problems of the ears, nose, throat and long-term airway problems, including tracheostomy.

Dr. Karas, a board-certified pediatric otolaryngologist, is the director of pediatric otolaryngology at Yale-New Haven Children's Hospital. He is also an assistant clinical professor of surgery in the section of otolaryngology and pediatrics at Yale School of Medicine.

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