Another u-turn in the controversy over antibiotics for ear infections in children

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To prescribe or not prescribe? That is the question that pediatricians have been grappling with over many years as they debate whether to use antibiotics to treat acute otitis media, or ear infections, in toddlers or whether to adhere to the “watch and wait” approach. From the New England Journal of Medicine come two new trials that attempt to settle the controversy by demonstrating that the use of antibiotics in infants and children under age two prevents relapse and disease progression even though the therapy is only modestly effective at reducing the duration of symptoms. In the first study, 291 children aged six to 23 months old with stringently defined acute otitis media diagnoses were given either the amoxicillin-clavulanate antibiotic Augmentin, or placebo for ten days. Sixty-seven percent of children on antibiotics demonstrated a sustained resolution of symptoms compared to only 53 percent of those taking placebo.

Recalling his days as a medical student and resident, ACSH's Dr. Gilbert Ross said that, “Back then, we regularly prescribed antibiotics to treat children we suspected of having a middle-ear infection, which we diagnosd based on nothing more than a fever and a painful red ear. But in the 1990s, studies began to indicate that you actually do more harm than good by prescribing antibiotics since the medicine can cause nasty side effects and most kids get over the illness on their own. In addition, the overuse of antibiotics can cause an overgrowth of resistant organisms. But now, this new research suggests that antibiotics can actually reduce the duration of symptoms and cause less recurrence of the disease in children.”

There are some children that should be placed on antibiotic therapies no matter what, however: Those younger than six months, those with a draining ear caused by a ruptured eardrum, those with early onset of severe symptoms and those with multiple infections.