For Kids' Earaches, Patience Can Count as Much as Antibiotics

Sept. 12, 2006 — -- The top reason doctors prescribe antibiotics for children is to cure an ailment that might not even require antibiotics, according to new research published in the Journal of the American Medical Association.

Every year, doctors write nearly 15 million prescriptions for antibiotics to treat earaches. But most of those earaches would clear up just fine without a prescription, studies indicate.

The overprescribing of antibiotics has been discussed for years, but oday's study looks at a "wait-and-see prescribing" practice, or WASP.

With WASP, doctors write a prescription and tell parents not to fill it unless the child fails to improve or gets worse 48 hours after the appointment. The United Kingdom, like many northern European countries, recommends the WASP approach.

In the new study, conducted by researchers at Yale and Vanderbilt universities, doctors examined about 300 children who were taken to emergency rooms with an earache. Half of the children's parents got a wait-and-see prescription for antibiotics, while the other half were told to fill their prescriptions immediately. All the children received ibuprofen and eardrops for pain.

Roughly two-thirds of parents in the wait-and-see group actually waited and did not fill their prescriptions. Those kids recovered just as quickly from their earaches as kids who got antibiotics right away.

Many doctors agree with the WASP approach and were not surprised that the approach was successful.

"As the great majority of kids with earaches do not need antibiotics and recover quite well without them, using them selectively makes a lot of sense," said Dr. Charles Shubin, medical director of the Mercy FamilyCare Children's Health Center in Baltimore.

Selective use of antibiotics is important because their overuse can have an impact on drug resistance.

Experts say using less of these drugs -- especially in kids -- will help maintain the drug's ability to work for future illnesses down the road, when they may be dearly needed.

"Clearly, it is our overuse of antibiotics that has led to a lot of the resistant infections we now see," Shubin said.

Some doctors criticized the way this study diagnosed and followed up on the children, because doctors in the study may not have accurately diagnosed the children's ear infections when they first arrived at the emergency room and did not follow up with the children at the end of the study, said Dr. Craig Derkay, former president of the American Society of Pediatric Otolaryngology.

"Multiple studies have shown that making an accurate diagnosis of [ear infection] is the single most important aspect of treating this disease effectively," Derkay said.

It's important that parents keep in mind that the recommendations do not mean parents shouldn't ever use antibiotics, said Dr. Joseph Zanga, a pediatrics professor at East Carolina University in North Carolina.

"Simply wait a bit," he said.

The WASP method also means parents must keep a close eye on their child's condition after a doctor's visit. That's because, Zanga said, serious complications, such as a ruptured eardrum or meningitis, can occur if a family neglected to fill a prescription for a child who was getting worse over the 48-hour window.