Routine Use of Antibiotics for Otitis Media (Earaches) Unproven

The results of a multinational study funded by the Agency for Health Care Policy and Research yielded surprising results. Eight international researchers from Britain, the Netherlands and the United States reported their findings after an exhaustive search of scientific literature on the use of antibiotics for children with Otitis Media. The paper produced by the group compared the differences in results in the United States and Britain, where the use of antibiotics is prevalent, with Iceland and the Netherlands where antibiotics are used very sparingly.

According to the researchers otitis media is the, "most common reason for outpatient antimicrobial (antibiotic) use" in the U.S. They found that about 30 percent of children under the age of three receive antibiotic treatment for acute ear infections each year. This astounding number is in stark comparison to the Netherlands where antibiotic use is not even included in the initial routine treatment of otitis media.

The paper created by these researchers asks and answers some hard questions concerning this issue. These questions and answers are quoted below.

"Does Treatment Improve Outcomes?"

"Nevertheless, since results are mixed and no study found large differences between placebo and antimicrobial groups, we conclude that the benefit of routine antimicrobial use for otitis media, judged by either short or long-term outcomes, is unproved."

"Does Treatment Prevent Complications?"

"Although preventing mastoiditis and meningitis is a rationale for antimicrobial treatment, little evidence exists that routine treatment is effective for this purpose."

"Do Children at High Risk Benefit from Antimicrobials?"

"No study has addressed whether antimicrobial treatment decreases the frequency of these (infections) in all or some of those with known risk factors."

"What is the Optimal Type and Duration of Administration?"

"In the nine country study, antimicrobials did not improve outcome at two months, and no differences in rates of recovery were found for either antimicrobial type or duration."

"No Compelling Evidence"

"After addressing these four questions, we conclude that existing research offers no compelling evidence that children with acute otitis media routinely given antimicrobials have a shorter duration of symptoms, fewer recurrences, or better long-term outcomes than those who do not receive them."

"What Is the Effect on Antimicrobial Resistance?"

"Antimicrobial use in children with otitis media results in the emergence of resistant organisms in those children and in the community. Although the organisms that cause otitis media are similar across countries, the Netherlands has a lower prevalence of resistant strains than other European countries."

"What Needs to be Done?"

"Research -- Placebo studies indicate that more than 80 percent of children with acute otitis media recover without antimicrobials."

"Prevention of acute otitis media -- Sufficient information exists to support aggressive encouragement of breast feeding and avoidance of tobacco smoke. There is insufficient evidence of effectiveness to recommend pneumococcal vaccine."

"Treatment of acute otitis media -- Clinicians should immediately reconsider the routine use of antimicrobials for children with otitis media and consider treating symptoms with analgesics and observation for lack of improvement."

"Increasing worldwide resistance of bacteria to antimicrobial drugs is causing a crisis manifested by higher morbidity, mortality and costs."