Are Antibiotics Worthwhile for Childhood Ear Infections?

Changes may be warranted in how doctors treat common acute childhood ear infections according to a study done by a researcher with the RAND Corporation, which conducts nonprofit research. Painful common acute ear infections, clinically known as acute otitis media, trouble millions of children every year and parents have become accustomed to pediatricians treating the infections with antibiotics, often using amoxicillin. This illness is the most common reason why antibiotics are prescribed for American children.

Dr. Tumaini R. Coker, a RAND researcher, who is a pediatrician at Mattel Children's Hospital UCLA, is lead author of the study which was published in the November 17, 2010 Journal of the American Medical Association. Dr. Coker explained that with antibiotics, ear infections may improve slightly sooner, but there's a trade-off in terms of possible side effects like diarrhea or rash.

The study goes on to describe the use of antibiotics to treat childhood ear infections as only "modestly more effective than no treatment" and was done, according to Rand, at the request of the American Academy of Pediatrics, which is attempting to update treatment guidelines.

The study team systematically reviewed other data published between 1999 and 2010, and concluded that without the use of antibiotic treatment, 80 out of 100 average risk kids with ear infections would get better within three days. Immediate antibiotic treatment would result in 12 more showing improvement, however the study states, "...three to 10 children would develop a rash and five to 10 would develop diarrhea."

Recommendations of this study serve to confirm opinions of others in recent years about how acute otitis media should best be treated.

Mayoclinic.com lists the usual symptoms of childhood ear infections as pain in the ear, especially when lying down, fever, fluid drainage from the ear, and trouble hearing. The Mayo Clinic information contains helpful tips about preventing ear infections in babies and kids. Along with the frequently advised ways to avoid infections in general, such as hand washing, they note that feeding a bottle fed baby in an upright position can help. Breast milk offers antibodies that guard against ear infection. Second hand smoke increases the risk to kids.

Dr. Coker's study further noted that the lack of a single definitive diagnostic test for childhood ear infections has limited doctor's attempts to improve treatment. Currently, diagnosis is mainly done by using an otoscope to view the eardrum.

Using name brand antibiotics rather than the commonly prescribed generics offered no advantage. About $350 is spent treating each occurrence of common childhood ear infection, and staying with cheaper generic amoxicillin could present substantial health care savings.
Sources:

Coker TR, Chan LS, Newberry SJ, Limbos MA, Suttorp MJ, Shekelle PG, Takata GS. Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children, Journal of the American Medical Association, November 17, 2010-Vol 304, No. 19.

RAND News Release, Antibiotic Treatment for Ear Infections in Children Provides Modest Benefits and Some Risks, RAND news and Events.

Mayo Clinic Staff, Ear Infection (Middle Ear), Mayoclinic.com