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Taking A "Wait-And-See" Approach To Childhood Ear Infections Is As Effective As Immediate Antibiotic

   Portland, Ore.

A new study reveals children whose parents take a "wait-and-see" approach to treating childhood ear infections get better at the same rate as children whose parents administer antibiotics. The research was led by the Director of Pediatric Emergency Medicine, Doernbecher Children's Hospital, Oregon Health & Science University, and will be published in the Sept. 13 issue of the Journal of the American Medical Association (JAMA).

"Most pediatricians have been trained to routinely prescribe antibiotics for ear infections and believe many parents expect a prescription. In fact, some 15 million such prescriptions are written each year," said David Spiro, M.D., M.P.H., principal investigator and Assistant Professor of Emergency Medicine and of Pediatrics, OHSU School of Medicine. "In this study, we found taking a wait-and-see approach is as safe, effective and quick as antibiotics in resolving most childhood ear infections.

"Ear infections, or otitis media, are the most common reason for which antibiotics are prescribed and, after a time, they are rendered useless in some patients as bacteria mutate and become resistant. Antibiotic resistance is a global public health concern and overprescribing them for ear infections is part of that problem," Spiro said.

To conduct this research, Spiro and colleagues at Yale University School of Medicine examined children aged 6 months to 12 years who came to the Emergency Department between July 2004 and July 2005. No other study on antibiotic use and ear infections has been conducted in an emergency department.

Participants diagnosed as having an ear infection were randomly assigned to one of two groups. One group was given a standard prescription for an antibiotic and told to fill it right away. The other group was given a prescription for an antibiotic and told to wait-and-see. Participants who received the wait-and-see prescription, or WASP, were told not to fill the prescription for 48 hours unless the child was either not feeling better or feeling worse. All participants were given medication for ear pain.

During the study enrollment period, 776 children were diagnosed with new ear infections. Of those, 138 were randomly placed in the WASP group and 145 were randomly placed in the standard prescription group. The participants were then interviewed at four- to six-, 11- to 14- and 30- to 40-day intervals. Parents were asked to provide the name and location of the pharmacy at which they filled the prescription. The researchers then called to confirm whether the prescription had been filled.

At the end of the year-long study, Spiro found two-thirds of participants in the WASP group did not fill the prescription and got better at the same rate as children whose parents filled the prescription. There was no significant difference between the two groups with regard to fever, ear pain or return visits for medical care.

Because Spiro and colleagues are emergency room physicians who typically do not have established relationships with the patients they treat, they were surprised to learn that such a large percentage of study participants, who did not have a prior relationship with the treating physician, followed their instructions and did not fill the prescription.

"Pediatricians and family practitioners everywhere should consider the wait-and-see, or WASP, approach for uncomplicated childhood ear infections," said Spiro. "Our study found WASP substantially reduced the need for antibiotics in children with ear infections seen in an emergency department and may be an alternative to routine use of antibiotics," Spiro said.

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