Wait-and-see approach lowers antibiotic use for ear infections

[Celebration]

http://www.vanderbilt.edu/news/releases/2006/9/13/wait-and-see-approach-lowers-antibiotic-use-for-ear-infections

Nashville (Tenn.) - A new study suggests that taking a wait-and-see approach before giving antibiotics to children with acute ear infections results in significantly lower use of antibiotics, with little difference in outcomes for the children.

The study's results, published this week in the Journal of the American Medical Association, are particularly timely. Resistance to antibiotics is a major public health concern worldwide, and acute otitis media (AOM, or ear infection) is the most common reason for prescribing antibiotics to children, at a rate of approximately 15 million prescriptions per year in the United States.

The study, co-authored by Vanderbilt's Donald H. Arnold, M.D., M.P.H., tracked emergency department visits of nearly 300 children, ages 6 months to 12 years. Participants were divided into wait-and-see prescription (WASP) group, where parents had the option of delaying use of antibiotics, and standard prescription (SP) group.

Researchers found that the WASP group significantly reduced the use of antibiotics: 62 percent of parents in that group did not fill the antibiotic prescription, compared with 13 percent in the SP group, resulting in an overall 56 percent reduction in antibiotic use. Although the WASP group had 2.4 days of earache versus two days in the SP group, there were no statistically significant differences between the groups in the frequency of subsequent fever or unscheduled visits for medical care.

[redqueen]

1. This is news?

That's been the standard procedure in Europe for goodness knows how long, IIRC...

I wonder why doctors / the medical community here wouldn't have pushed this sooner, given the trend in antibiotic resistant bacteria.

[Warpy]

3. It's been the standard of care here, as well

but pediatricians confronted by parents frantic to heal their screaming tolddlers will usually just write the scrip rather than taking time to explain and lecture.

The kids would be much better served by a mild painkiller like liquid Tylenol with codeine, with a scrip called in 3 days later if it hadn't resolved.

Giving antibiotics out like candy is only making sure the bugs become immune to them that much faster. There is also some information that it weakens the kid's immune system by not allowing it to gear up and fight the infection on its own.

[redqueen]

4. Is that the exception, or the rule?

I have actively argued with my kids' doctor about antibiotics for ear infections, but she insisted they be given, even as she agreed with me that antibiotics were overprescribed, for just the reasons you state. Obviously that wasn't the case with me, so why she pushed them, I don't know.

I would have ignored her advice, but my co-parent insisted we do as the doctor said.

Grr.

[Warpy]

5. Good for you for ignoring bad advice.

Some docs still insist giving antibiotics for viral illnesses in children decreases the chance of a bacterial infection down the line. While it does, studies have shown that most kids don't develop a secondary infection.

A good guideline can be found at http://pediatrics.about.com/cs/commoninfections/a/ear_inf_gdlns.htm

[sandnsea]

6. Always the case with my docs too

I've never known a pediatrician to take the wait and see approach with my kids, even though that's what I would have preferred. In fact, I'd bet money that child services have been involved with kids who weren't treated for ear infections. I mean - they could get a hole in their esophageal tube!!! That's what they always scared us with when my kids were little.

[rodeodance]

2. and Moms have to miss work for the most part for this wait and see. I