Antibiotics best for battling ear infections, Pitt study says

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It's the most commonly diagnosed childhood illness in the United States.

But for decades, debate has raged on how best to treat childhood ear infections.

A University of Pittsburgh study, to be published today in The New England Journal of Medicine, aims to provide the definitive word on whether to treat ear infections with antibiotics.

The study found that the use of antibiotics lessened the symptoms of ear infections and cleared the ear infections faster.

"Provided that the diagnosis is certain, we generally favor treatment with antibiotics with all children," said Alejandro Hoberman, lead author of the study and chief of the Division of General Academic Pediatrics at Children's Hospital of Pittsburgh of UPMC.

The Pitt study was conducted between November 2006 and March 2009 with 291 Western Pennsylvania children aged 6 months to 23 months.

Among the children who received the 10-day course of the amoxicillin-clavulanate antibiotic, 35 percent had initial resolution of their symptoms by day two, 61 percent by day four and 80 percent by day seven. For children who received the placebo, 28 percent had resolution by day two, 54 percent by day four and 74 percent by day seven.

While antibiotics have been -- and for the most part continue to be -- the standard treatment for ear infections in the United States, concerns about overuse of antibiotics have decreased their use in European countries.

Research beginning in the 1980s seemed to endorse a strategy of "watchful waiting" in which antibiotics are administered only if symptoms do not improve after several days.

In 2004, the American Academy of Pediatrics and the American Academy of Family Physicians endorsed a guideline recommending observation instead of immediate antibiotics for some children.

Dr. Hoberman criticized the design of some of the studies that led to the watchful waiting strategy, noting that limitations included insufficiently stringent diagnostic criteria, a limited number of very young children and insufficient doses of antimicrobial drugs.

Farrel Buchinsky, a pediatric otolaryngologist at Allegheny General Hospital, praised the Pitt study for addressing the shortcoming of previous research.

"It's a very well done study," he said. "It took care of every nuanced controversy that has bedeviled the field in the past."

He questioned, however, whether the study's findings actually make the case for prescribing antibiotics for all children with ear infections.

"As far as I'm concerned, antibiotics do play a role in the treatment of ear infections but they're not a silver bullet," said Dr. Buchinsky, who also is an associate professor of otolaryngology at Drexel University College of Medicine. "It's not unreasonable to do watchful waiting -- particularly when someone is not having a severe bout."

The Pitt study found that antibiotics appeared to be dramatically effective in treating cases of "clinical failure," in which signs of an acute infection were still visible with an otoscope -- a medical device used to look inside the ears -- after four days.

The rate of clinical failure at day four or five was 4 percent for children treated with the antibiotic versus 23 percent for children treated with a placebo.

The study did find some side effects with the use of antibiotics, namely higher incidences of diarrhea and diaper rash.

For that reason, and because of general concern about antibiotic overuse, Dr. Hoberman stressed the importance of getting an accurate diagnosis before treating an ear infection with antibiotics.

He discouraged the practice of prescribing antibiotics in borderline cases "just in case" the infection gets worse, urging parents and doctors to wait until there are clinical signs such as a bulging eardrum.

"The key to management of acute otitis media is an accurate diagnosis," he said, referring to the formal name for ear infections.

Armed with their study findings showing that a 10-day course of antibiotics can make a difference in treating ear infections, Dr. Hoberman and his team at Pitt recently received funding for a six-year, $8 million follow-up study to investigate the effectiveness of short-course antibiotics. The study will enroll more than 600 children to compare a five-day course of antibiotics with the standard 10-day course.

Anya Sostek: or 412-263-1308.


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