Published November 17, 2010
The benefits of treating kids' ear infections with antibiotics may not always outweigh the costs in side effects and dollars spent, suggests a new review of more than 100 studies on the topic.
Children in the U.S. receive antibiotics for acute ear infections more often than for any other illness. All this medicating contributes to an estimated $2.8 billion dollars, or $350 per child, spent annually to treat the condition.
"We found that antibiotics did offer a modest benefit in treating ear infections in children, but they were also associated with an increased risk of side effects, such as rash and diarrhea," lead researcher Dr. Tumaini R. Coker of the University of California, Los Angeles, told Reuters Health in an e-mail.
"A substantial savings in the costs of treatment could be seen by using a less aggressive approach to prescribing antibiotics," she added.
To help inform updated American Academy of Pediatrics guidelines for the treatment of kids with ear infections, Coker and her colleagues identified 135 relevant studies published between January 1999 and July 2010.
Overall, the studies showed slightly better ear infection improvements for kids on antibiotic treatment compared to no treatment. Within 14 days, 73 percent of kids had recovered while on antibiotics whereas only 60 percent had recovered with no treatment.
Immediate treatment with antibiotics was also more successful compared to delayed treatment, report the researchers in the Journal of the American Medical Association.
However, they also found that antibiotics led to an increase of 3 to 5 percent in the rate of rash or diarrhea.
"The number of children that would benefit from antibiotics is fairly similar to the number who would have side effects from the antibiotics," said Coker.
If you have 100 healthy children with an acute ear infection, she explained, 80 would be expected to get better within three days with only over-the-counter medications for pain or fever and no antibiotics.
If all 100 were treated with antibiotics, on the other hand, the number expected to improve would rise to 92. But three to 10 children would develop rash and five to 10 would likely develop diarrhea.
There was no available data on the long-term effects of antibiotic treatment on the occurrence of resistant infections, another concern with the overuse of the drugs.
"Our findings suggest that for many children, a period of observation without antibiotics may be the best option in treating acute ear infections," noted Coker.
And if a doctor does decide to prescribe an antibiotic, classic amoxicillin is still a "reasonable first choice," she said, adding that the newer or more expensive antibiotics didn't appear to work any better.
"Parents should know that antibiotic treatment may not always be the best option for treatment when their child has an acute ear infection," added Coker. "But it is important to see their doctor and together they can weigh the benefits and risks of antibiotics."