The last thing parents want to see is their child in pain – and the pain and discomfort of an ear infection is a time of sadness, sleeplessness nights and worry for everyone. But it is possible to make a bad thing worse.
Most of the time, the parents’ immediate response is to see a physician who will then make the make their own “immediate” decision for treatment – usually antibiotics. For many years the first line of treatment for ear infections in children has been a full regimen of pills for 7-14 days. Children usually get better, but at what cost?
A recent research study published in the November 17th issue of the Journal of the American Medical Association (JAMA) explores the cost/benefit of using this traditional treatment method, and what the researchers found reinforced previous studies on antibiotic use for treating ear infections: don’t do it.
The study was funded by the Southern California Evidence-Based Research Center, a joint center of the RAND Health and The Agency for Healthcare Research and Quality. It is a follow up to their 2001 analyses of outcomes from antibiotic treatment for the most common type of ear infection in children, acute otitis media or more commonly know as the middle ear infection. The intention was to review current treatment guidelines for common illnesses and make recommendations to physicians for best course of action.
They found that treatment guidelines varied from physician to physician, largely due to the fact that there is not a standard test for diagnosis. The process, up until now, relies heavily on a visual inspection of the ear for swelling and redness of the interior areas. Whether or not antibiotics are prescribed is dependent upon the physicians’ conclusion. The concern is that that there was not a standard methodology used that defined how much redness and swelling warranted antibiotic treatment. Even when a diagnosis was made and treatment administered, positive outcomes from antibiotic use was negligible, meaning they worked but only slightly better than no treatment.
Even in those cases where antibiotics did work, it’s questionable if the benefit of this type of treatment outweigh the costs. Common side effects to a regimen of antibiotics include diarrhea, rash, nausea and – overtime – antibiotic resistance. Dr. Tumaini Coker, lead researcher and a pediatrician at Mattel Children’s Hospital UCLA argues that prescribing antibiotics early for children may help in the short term, but increases the risk that they will suffer from side effects while they are still moving through the pain of the infection. Sounds like a pretty awful week for a child.
Past research has come to a similar conclusion. A study out of the University Medical Center Utrecht, the Netherlands, analyzed data from 1,328 children diagnosed with acute middle ear infections who were between the ages of 6 months and 12 years. 660 of the children were given placebos and the remainder antibiotic treatment. Their conclusions backed up this recent research report – the effect of the antibiotic treatment was marginal; the pills did very little to prevent fluid build up in the middle ear which is a common consequence to ear infections. They recommended not prescribing antibiotics for treatments knowing that the negative side effects far outweighed a tiny benefit.
The conclusion of the both research papers : there was very little evidence that name brand antibiotics work any better than generic formulas, and the best treatment for ear infections may be no treatment at all. The good news is that there is research in the works that will aid in the discovery of treatments that are more than marginally effective.
What’s a parent to do? First of all, knowing the outcome of this latest study can provide a good dose of empowerment through knowledge. Consider that the side effects may outweigh the benefits of antibiotics for our children … and that for many families time and diligent monitoring by both the parents and physicians may be good medicine as well. Make informed choices.
A copy of the report can be found here at the Agency for Healthcare Research and Quality.
— Makenna Berry