With the level of risk for long-term effects called into question, a controversy now exists regarding whether traditional treatment of pediatric ear infections has been too aggressive, and whether, perhaps, the treatment itself is responsible for undesirable long-term effects.
‘Wait-and-See’ Approach to Antibiotic Usage
Physicians write approximately 15 million prescriptions annually in the United States for antibiotics to treat acute otitis media (AOM), at an estimated cost of $10 to $100 per course of therapy. The risks of antibiotics—including gastrointestinal upset, allergic reactions, and accelerated antibacterial resistance—have many researchers questioning whether the benefits of such widespread antibiotic therapy justify these risks.
The American Academy of Pediatrics and American Academy of Family Physicians Clinical Practice Guideline for Diagnosis and Management of Acute Otitis Media, published in Pediatrics in 2004, calls for “judicious use of antibacterial agents” (Pediatrics 2004;113:1451–1465). These guidelines endorse the option of observation without the use of antibacterial agents in a child with uncomplicated AOM based on diagnostic certainty, age, illness severity, and assurance of follow-up. This option refers to delaying the use of antibiotics for 48 to 72 hours for selected children. The guidelines cite studies over the past three decades consistently showing that between 7 and 20 children must be treated with antibacterial agents for one child to derive benefit. In placebo-controlled trials, 61% of children have decreased symptoms at 24 hours whether or not they received antibiotics.