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Inner Ear Infections: Still No Need For Antibiotics

Kids get inner ear infections and then they get antibiotics, despite a long-standing knowledge that it’s not always best. Any physician knows this, but who hasn’t faced an irate or anxious parent in the exam room insisting on a prescription, whether the evidence warrants it or not?

Reuters reports that the tally for all those antibiotics is $2.8 billion dollars, or $350 per child annually. And there’s only a slight benefit to them.

While hardly comforting to the parents, physicians can add more heft to their argument that antibiotics are only modestly more effective than nothing, and they can avoid the rashes and diarrhea that antibiotics incur.

Results in the Nov. 17 issue of the Journal of the American Medical Association (JAMA) reported that:

–Otoscopic findings of tympanic membrane bulging (positive likelihood ratio, 51 [95% confidence interval [CI], 36 to 73]) and redness (positive likelihood ratio, 8.4 [95% CI, 7 to 11]) were associated with accurate diagnosis.

–Heptavalent pneumococcal conjugate vaccine (PCV7) changed the microbiology of inner ear infections. Before and after PCV7, Streptococcus pneumonia decreased (33%-48% vs. 23%-31% of acute otitis media isolates), while Haemophilus influenza increased (41%-43% vs. 56%-57%).

–Short-term clinical success was higher for immediate use of ampicillin or amoxicillin vs. placebo (73% vs. 60%; pooled rate difference, 12% [95% CI, 5% to 18%]; number needed to treat, 9 [95% CI, 6 to 20]), but increased rashes or diarrhea by 3% to 5%. Two studies showed greater clinical success for immediate vs. delayed antibiotics (95% vs. 80%; rate difference, 15% [95% CI, 6% to 24%] and 86% vs. 70%; rate difference, 16% [95% CI, 6% to 26%]).

The lead author told Reuters that an observation period without antibiotics may be the best option, and plain old amoxicillin works just as well as anything else.

The meta-analysis adds to the physician’s understanding of antibiotics. Whether it adds to the parents’ is another story.

*This blog post was originally published at ACP Internist*


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