Watchful Waiting vs. Prescription Antibiotics in the Treatment of Acute Otitis Media

There’s a new battleground in the fight to curb antibiotic overprescribing and control the spread of resistant superbugs: the common ear infection, or acute otitis media (AOM). Although a growing body of literature shows that most kids with ear infections recover with no complications without the use of antibiotics, many physicians continue to prescribe antibiotics for the vast majority of children diagnosed with an ear infection.

A February 16 Wall Street Journal article offers an excellent summary of the debate over whether to treat bacterial ear infections aggressively with antibiotics or to adopt a watch-and-wait approach in most cases.

The article notes that “Current guidelines from the American Academy of Pediatrics and the American Academy of Family Physicians say that many patients, except the youngest and the sickest, can safely go without an antibiotic. Still, American doctors continue to prescribe the drugs very broadly for ear infections—to 84% of the kids they diagnose with them, according to a new analysis published in this month's issue of the journal Pediatrics.”

The authors of the Pediatrics article wrote that they “found no compelling evidence that the 2004 AAP/AAFP guideline for AOM treatment substantially increased the proportion of the pediatric AOM cases being managed without antibiotics.”

Other key points from the WSJ article:

• Research in a June 2009 issue of BMJ “suggested that children who got antibiotics might be more likely to have recurrent infections.”

• Many physicians who favor the use of antibiotics in AOM “question the methodology of many of the clinical trials, particularly that they may have included patients who didn't have true bacterial ear infections,” which could “dilute the evidence of the antibiotics' effectiveness.”

• A 2007 survey of primary care doctors found that 65% of respondents said that “parents' demand for antibiotics was the most important barrier to holding off on prescriptions” for antibiotics for children diagnosed with AOM.

• One pediatrician cited in the article said that he “tells parents that the chance of a child getting better within a few days without an antibiotic is about 80%, while with the drug it is around 90%.” He also tells parents that they treat their children with ibuprofen for pain, as per recommendations in the current guidelines.

• Richard Rosenfeld, chairman of otolaryngology at Long Island College Hospital, said that “new research can help doctors ‘target the antibiotics better,’ for kids who need them, who seem to include children under the age of 2 with infections in both ears, as well as those whose ear drums are oozing pus.”

What’s your opinion on this matter?

What is your preferred method for treating children diagnosed with acute otitis media?

What signs and symptoms do you watch for before deciding to treat with antibiotics?

What is your antibiotic of choice: guideline-recommended amoxicillin or an alternative agent?

How much do parents’ requests for treatment with antibiotics influence your decision-making process?