December 7, 2010

Kids' Ear Infections

Antibiotics may make the pain go away faster, but they are rarely necessary. There are also significant risks.

A review of published studies from the last decade has found that use of antibiotics to treat children's ear infections is a mixed blessing. Some children recover more quickly, but there is also a downside: a nearly equal number experience side effects, such as diarrhea or rash.

Most children's ear infections get better within three days, with or without antibiotics.

'Our findings reinforce the existing knowledge that the best antibiotic treatment for common childhood ear infections may be no antibiotic treatment at all.'

The study's lead author notes that for some parents, the slight benefit will outweigh the side effects, for others it won't. Her summation of the results: "Our findings reinforce the existing knowledge that the best antibiotic treatment for common childhood ear infections may be no antibiotic treatment at all."

The review was requested by the American Academy of Pediatrics to help update its guidelines fore treating ear infections. The review only looks at the short-term health benefits of taking antibiotics, it does not look at long-term effects such as increased antibiotic resistance in bacteria.

There is currently no definitive test to diagnose ear infection. The study found that using an otoscope to look inside the ear is the best way of determining whether or not an ear actually is infected and encourages clinicians to do so. The study also found that older generic antibiotics, such as amoxicillin, were as effective at treating ear infections as newer, more expensive ones are.

The review authors looked at 135 studies published between 1999 and 2010. They found that, on average, 80% of all children's ear infections get better within three days. When treated with antibiotics, this rises to 92%, but 5-10% of the children will develop diarrhea and 3-10% will develop a rash.

While this may pose a difficult choice for parents, it's important that they try to make one. Their desires have a strong effect on the doctor's choice of treatment.

A 2009 Italian study found that parental expectation of an antibiotic prescription was the second leading reason that doctors prescribed antibiotics for children's respiratory infections. The doctors did not think that parents' expectations had much influence on their prescription practices; the study statistics said that when doctors thought parents expected antibiotics, they were much more likely to prescribe them.

The review of the effect of treating children's ear infections with antibiotics appears in the November 17, 2010 issue of the Journal of the American Medical Society (JAMA).

The 2009 study, Why do paediatricians prescribe antibiotics? Results of an Italian regional project, was published in the November 6, 2009 issue of the open-access journal BMC Pediatrics and is freely available.

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