Antibiotics for ear infection in kids better than watchful waiting: Study

By Dr. Ananya Mandal, MDJan 12 2011

Findings from two latest clinical trials reveal that a young child with ear infections recovers faster and more completely if doctors give antibiotics right away rather than waiting to see if the kid get better on his/her own. One of the studies was in the U.S. and one in Finland. Earlier it has been debated that for young children with middle ear infections or otitis media whether immediate antibiotic treatment was better than watchful waiting. Current treatment recommendations in the U.S., Canada, and Europe allow for a watch-and-wait approach to suspected middle ear infections in young children. Change is coming, predicts study leader Alejandro Hoberman, MD, of Children’s Hospital of Pittsburgh.

Hoberman said, “The real issue for children with acute otitis media is that the circumstances for when to give antibiotic treatment are unclear… I truly believe, based on our results, that once they are diagnosed properly, more young children will recover more quickly when treated with antibiotics.” According to Jerome Klein of Boston University School of Medicine, who specializes in infectious diseases and is an independent observer, U.S. pediatricians wait and watch only when the diagnosis of otitis media is uncertain. In Canada and many European nations, doctors are more likely to wait. He said, “What these studies do is refute the European experience, and support the opinion of most U.S. doctors and parents that otitis media is a treatable disease.” The study appeared in the Jan. 13 issue of the New England Journal of Medicine.

National Institute of Allergy and Infectious Diseases Director Anthony Fauci, added that the new studies show that when doctors diagnose otitis media using strict criteria, antibiotic treatment is best. “It was very clear that the duration of symptoms were clearly better in the kids who took antibiotics,” he said.

In the Finnish study Paula A. Tahtinen and colleagues at Turku University studied 319 children aged 6 to 35 months with acute otitis media. Half were treated with a seven-day course of Augmentin, a powerful antibiotic containing Amoxycillin and clavulanic acid. The other half were given inactive placebos. Only 18.6% of the children treated with antibiotics got worse or failed to improve, compared with 44.9% of the children in the placebo group. However, nearly half the children treated with antibiotics had diarrhea, compared to only about a quarter of the kids in the placebo group.

In the US study the University of Pittsburgh team studied 291 children aged 6 to 23 months with acute otitis media. Again, half were treated with Augmentin for seven days, while half received a placebo. Four or five days after Augmentin treatment, only 4% of kids got worse or failed to improve. This was nearly six times better than the 23% of kids who got worse or no better on placebo. Children who got the antibiotics were much more likely to get diarrhea and diaper rash. But they also were far less likely to suffer severe complications, such as a perforated eardrum.

Hoberman advises, “Our study underscores the need to treat only kids who meet stringent criteria for a diagnosis of otitis media… lf that is the case, we won’t have to treat half the kids now getting antibiotics for uncertain ear infection. The idea is to stick with the ones that have strictly defined otitis media.” Dr. Michael Rieder of the Canadian Pediatric Society however says the studies should offer pediatricians good guidance. He said, “For years, we have treated them without a lot of science guiding us. Now we are getting data that is allowing us to treat based on evidence-based science, which is great.”