Ear Infection Update

Antibiotics may help ease children's ear infections.
The Los Angeles Times (1/13, Maugh) reports, "The medical consensus on whether to give antibiotics to young children with ear infections has been swinging from one extreme to the other as conflicting clinical trials have pushed pediatricians first toward widespread use of the drugs, then toward a 'watch and wait' approach in which most infections seem to clear up on their own." Now, however, "two new trials reported Wednesday in the New England Journal of Medicine are nudging the pendulum back toward treatment of the infections, especially for the youngest children." They indicate that "the use of antibiotics in infants and toddlers under the age of two is only modestly effective and reduces the duration of symptoms by only a small amount, but it prevents relapses and progression of the disease."
Bloomberg News (1/13, Ostrow) emphasizes the importance of the new research, since "three of four children will have at least one ear infection by the time they turn three years old, according to the US National Institutes of Health." NIH defines "an ear infection [as] an inflammation of the middle ear, which occurs when fluid builds up behind the eardrum," and "is usually caused by bacteria."
The Washington Post (1/12, Huget) "The Checkup" blog reported that both studies "show that antibiotics are more effective than placebos in relieving ear-infection symptoms such as fever, poor appetite, decreased activity and irritability, and suggested that their benefits warrant their being administered early on, regardless of the seeming severity of a child's symptoms." The studies also noted, however, that "the use of antibiotics must be weighed against the risk of antimicrobial resistance, to which prescriptions for childhood maladies, such as ear infections, are thought to contribute mightily, and against antibiotics' side effects, which can include diarrhea and eczema."
The NPR (1/13, Knox) "Shots" blog reported that both studies "come down firmly on the side of early antibiotic therapy for kids under age two or three," finding that these children "get over painful ear infections faster, and have less severe symptoms, if they get prompt treatment with Augmentin [amoxicillin clavulanate], an inexpensive antibiotic often used to treat respiratory infections." Nevertheless, the "study authors and other experts say doctors should be sure the child really is suffering from an ear infection before writing that prescription."
HealthDay (1/12, Salamon) reported that in the first study, "291 children between the ages of six months and 23 months old with certain ear infections -- as defined by the presence of a bulging eardrum and parental observations, among other symptoms -- were split into groups receiving antibiotics or placebos for 10 days." Researchers found that "among those who received amoxicillin-clavulanate, 35 percent had initial resolution of symptoms by day two; 61 percent by day four; and 80 percent by day seven. In contrast, of those on placebo, 28 percent had initial resolution of symptoms by day two, 54 percent by day four and 74 percent by day seven," investigators found.
According to WebMD (1/12, DeNoon), in the second study, researchers followed "319 children aged six to 35 months with acute otitis media," half of whom were randomized to placebos and the other "half were treated with a seven-day course of Augmentin." The investigators discovered that "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."
MedPage Today (1/12, Bankhead) reported, "Collectively, the two studies provided a clear answer to an unresolved clinical question, Jerome Klein, MD, of Boston University Medical Center, wrote in an accompanying editorial." Klein wrote, "More young children with a certain diagnosis of acute otitis media recover more quickly when they are treated with an appropriate antimicrobial agent." Medscape (1/12, Barclay, subscription required) also covered the story.