Are Antibiotics for Ear Infections Worth the Risk?

Using antibiotics to treat newly diagnosed acute ear infections among children is modestly more effective than no treatment, but comes with a risk of side effects, according to a new study designed to help advise efforts to rewrite treatment guidelines.

In the study, which is published in the Journal of the American Medical Association, researchers found no evidence that name-brand antibiotics work any better in general than generic antibiotics and that careful examination of the eardrum by a clinician for signs of infection is critical for accurate diagnosis of acute ear infections.

"Our findings reinforce the existing knowledge that the best antibiotic treatment for common childhood ear infections may be no antibiotic treatment at all," said lead author Tumaini R. Coker, MD, a pediatrician at Mattel Children's Hospital UCLA and a researcher at the RAND Corporation, in a statement.

"Prescribing antibiotics early may help cure ear infections a little bit faster, but also raises the risk that children will suffer antibiotic-related side effects such as a rash or diarrhea," Coker said. "Parents and their children may value these different outcomes differently."

The study reviews published data from 1999 to 2010 on the treatment of acute ear infections among children; a systematic review of the literature found that prescribing antibiotics early for acute ear infections had a modest benefit. Of 100 average-risk children with acute ear infections, about 80 would be expected to get better within about three days without antibiotics, the researchers found. If all were treated with antibiotics immediately at diagnosis, evidence suggests an additional 12 would improve, but three to 10 children would develop a rash and five to 10 would develop diarrhea.

"Early prescribing of antibiotics offers a slight benefit and poses a slight risk," said the study's senior author, Glenn Takata, MD, of Children's Hospital Los Angeles. "Clinicians will have to take these modest benefits and risks into consideration when deciding whether to treat with antibiotics or not."

Researchers also found no evidence that using newer, name-brand antibiotics to treat uncomplicated acute ear infections in normal-risk children offers an advantage over generic antibiotics, namely the commonly-used amoxicillin. Despite these findings, the higher-priced antibiotics are often prescribed for uncomplicated acute ear infections. Savings could be substantial if physicians used amoxicillin as the first line of defense against uncomplicated acute ear infections, according to researchers.

For more:

• Watchful Waiting vs. Prescription Antibiotics in the Treatment of Acute Otitis Media
• The Antibiotic Minimalist: The Patient as Partner
• Tympanocentesis for Treatment of Acute Otitis Media

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