New Ear-Infection-Treatment Approach Cuts Antibiotic Use

The majority of parents instructed to take a "wait-and-see" approach to treating their children's ear infections opted against filling antibiotic prescriptions, a new study showed Tuesday.

The so-called "wait-and-see" or watchful waiting approach was adopted in 2004 by a joint committee of the American Academy of Pediatrics and the American Academy of Family Physicians for treating acute otitis media, or ear infections in children, partly to cut down on the proliferation of drug-resistant bacterial strains. Most ear infections also clear on their own without antibiotics.

As part of the wait-and-see approach, most parents with children over age 2 are given an antibiotic prescription but then instructed to fill it only if their child either doesn't improve or gets worse over the following 48 hours. Doctors also advise parents to give children over-the-counter pain medication like ibuprofen for pain and fever.

Now a new study, published in this week's Journal of the American Medical Association, suggests many parents are comfortable skipping the antibiotics. Before the new policy was adopted, an estimated 15 million prescriptions were filled annually to treat children's ear infections. New Drugs in Development

David M. Spiro, formerly of the Yale University School of Medicine, New Haven, Conn., and colleagues studied children who had been diagnosed with an ear infection during an emergency-room visit between July 2004 and July 2005.

Overall, 138 children aged 6 months to 12 years were put into the wait-and-see group and 145 were assigned to a "standard prescription" group where they were given a prescription and told to fill it. In both groups the prescription expired three days after the visit unless it was filled. All patients received ibuprofen for pain as well as eardrops for pain.

Researchers found that 62% of parents in the wait-and-see group never filled the prescriptions, reporting that kids got better on their own, while just 13% of parents in the "standard prescription" never had it filled.

Spiro, who now heads the pediatric emergency medicine department at the Oregon Health and Science University in Portland, says while the wait-and-see approach is still controversial among many doctors but that he finds his patients are fine with the policy.

He explained that study results showing that nearly two-thirds of parents opted to not have their prescriptions filled in an emergency-room setting where they have no relationship with a doctor was significant. He believes patients are even more likely to go along with the wait-and-see approach in an office setting because they typically trust their pediatricians.