Researchers Review Effectiveness of Treatment for Ear Infections
If your child suffers from frequent ear infections, you may want to discuss some new research findings with your pediatrician.
Results from exams with an otoscope -- the instrument a physician uses to examine the interior of the ear -- are critical in diagnosing ear infections, and antibiotics are only modestly more effective in treating middle ear infections than no treatment at all, according to an article appearing in the Nov. 17 issue of JAMA.
Acute otitis media (AOM), or middle ear infection, is the most common childhood infection for which antibiotics are prescribed in the U.S., at an average cost of $350 per year per child with AOM -- for a total of $2.8 billion, according to a 2006 study cited by the authors.
"Timely and accurate diagnosis and appropriate management of AOM may have significant consequences for ambulatory health care utilization and expenditures," the authors write. "... however, wide variation exists in diagnosis and treatment."
For the current study, the authors conducted a review of relevant research to support the new AOM treatment guidelines, which are soon to be released by the American Academy of Pediatrics. In doing so, the researchers looked factors such as the precision and accuracy of AOM diagnosis, use of the PCV vaccine as part of a treatment regiment and the decision as to whether AOM should be treated with antibiotics -- including the effectiveness of different antibiotics and any associated adverse reactions.
The researchers found that otoscopic findings of tympanic membrane bulging and redness were associated with an accurate AOM diagnosis. As such, they suggest the most important way to improve diagnosis is to improve a physician's ability to recognize and rely on key otoscopic findings.
In other findings, the authors report higher success rates for immediate treatment with ampicillin or amoxicillin, although these medicines may cause rash or diarrhea.
"Of 100 average-risk children with AOM, approximately 80 would likely get better within about three days without antibiotics," the authors write. "If all were treated with immediate ampicillin/amoxicillin, an additional 12 would likely improve, but three to 10 children would develop rash and five to 10 would develop diarrhea."
The authors suggest that physicians need to weigh these risks -- including possible long-term effects on antibiotic resistance -- and benefits before prescribing immediate antibiotics for uncomplicated middle ear infections.
In conclusion, the authors suggest further research is needed to examine physicians' diagnostic accuracy and precision with regard to AOM, assess the effectiveness of the newly-approved PCV13 vaccine and further study the issue of antibiotic treatment.
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