Antibiotics Not Needed for Most Ear Infections

A study published in the September 13, 2006 Journal of the American Medical Association (JAMA) shows that "watchful waiting" is better than using antibiotics for the treatment of ear infections known as Acute Otitis Media (AOM).  The study starts off by noting that AOM is the most common diagnosis for which antibiotics are prescribed to children.

In this study 283 children ages 6 months to 12 years seen in a hospital emergency department, with acute ear infections were divided into two groups.  One group was treated only by the "wait-and-see prescription", known as the WASP group.  The second group was known as the SP group which stood for "standard prescription".  The authors noted that previous studies did not include severe cases as would be seen in the emergency room as with these cases.

The "wait-and-see prescription" group of children did get a prescription for antibiotics, but their parents were advised to wait and see for 48 hours before considering filling the prescription.  These parents were  asked not to fill the prescription they were given unless the child either is no better or is worse in 48 hours.  The "standard prescription" group got a prescription for antibiotics and were not given any instructions to wait and see. 

The results showed that 62% of the prescriptions in the WASP group were never filled. Conversely, about 90% of the children in the "standard prescription" group whose parents were not asked to wait and see wound up taking the antibiotics. Even more interesting is that the researchers found that, "There was no statistically significant difference between the groups in the frequency of subsequent fever, otalgia (pain), or unscheduled visits for medical care."  In essence the group that did not take antibiotics did just as good as the group that took the medication.

Lead researcher, David M. Spiro, MD, commented in a WebMD article by saying, "In this country, 96% to 98% of physicians treat ear infections immediately with antibiotics, even though most cases will resolve on their own without treatment."  In the conclusion of the study, Spiro and co-authors stated, "The WASP (wait-and-see-prescription) approach substantially reduced unnecessary use of antibiotics in children with AOM (acute otitis media) seen in an emergency department and may be an alternative to routine use of antimicrobials for treatment of such children.

It should be noted that in 2004 the American Academy of Pediatrics gave their approval to the wait-and-see approach and stated that 80% of children whose ear infections are not treated immediately with antibiotics get better on their own.