Is medication mandatory?

Antibiotics may not be needed for all ear infections


Joanna Broder

Health roundup - November 2006 Before rushing to fill a prescription for a child's ear infection, parents may consider just waiting a day or two to see if she really needs that antibiotic after all.

A recent study published in the Journal of the American Medical Association found that if parents were asked to wait a few days before filling a child's antibiotics prescription for an ear infection, they were much less likely to actually use it than parents who were told to get the prescription right away.

"There's a lot of benefit to waiting and watching," says Dr. Ruben Rucoba, a pediatrician at Wheaton Pediatrics and a clinical instructor of pediatrics at Northwestern's Feinberg School of Medicine.

Eighty percent of children will have at least one ear infection before the age of 5, Rucoba says. According to the study's authors, though, most of these infections are apt to cure themselves in time, whether children take antibiotics or not.

Other industrialized countries (such as those in Europe) do not generally treat ear infections with antibiotics and they have no higher incidence of significant problems such as hearing loss or more serious infections, Rucoba says.

The study included parents of 145 children, ages 6 months to 12 years who were diagnosed with an ear infection in an emergency room. Children were randomly selected for the standard prescription group where parents were given an antibiotics prescription and told to get it right away. Others received a prescription but were advised to wait to fill it only if the child had not improved within 48 hours or had gotten worse. Children in both groups were given ibuprofen and numbing ear drops to treat the pain.

Sixty-two percent of the parents in the "wait-and-see" group did not end up filling their prescriptions compared to 13 percent in the standard group. There was no significant difference between the two groups regarding their children's frequency of fevers, ear pain or unplanned visits for medical care. The "wait-and-see" method reduced the use of antibiotics by 56 percent in children with ear infections, authors found.

Using antibiotics more sparingly slows the growth of antibiotic-resistant bacteria, a growing problem. "The more antibiotics that are used for any reason, the more antibiotic resistance we perpetuate in the community," Rucoba says.

He says parents pressure him all the time to prescribe antibiotics for colds and sore throats even after strep has been ruled out. Because these are viral infections, antibiotics won't help, he explains. "Parents need to understand that there are really not that many indications for antibiotics in children," he says. "The judicious use of antibiotics is the responsibility of everybody."

If parents fail to treat a bad ear infection with antibiotics "not much bad really does happen," Rucoba says. Occasionally, the ear drum can rupture, but even that would eventually heal. In very rare instances an untreated, severe ear infection can lead to Mastoiditis, a severe bone infection, or meningitis. But according to Rucoba, using the "wait-and-see approach does not make these conditions any more likely."

Joanna Broder is a writer living in Evanston with her husband.

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