Antibiotics Hearing Loss For many parents, those could-turn-nasty middle-ear infections in their youngsters can set off a noisy internal debate: Treat them with antibiotics or let nature take its course?
Now researchers at the Children’s Hospital of Eastern Ontario, Canada are able to offer some advice after a study of more than 500 children five and under found that 84 per cent of moderately severe middle-ear infections cleared up without an antibiotic, compared to 93 per cent with the drug.
“I think this study does give the ammunition for the physician to discuss with the parent and say, ‘Look, you’re right, we don’t want to prescribe antibiotics unnecessarily,’ ” said Dr. Nicole Le Saux, a pediatrician at the Ottawa hospital and principal investigator of the study.
“And in this study, at least, your child has an 84 per cent chance of getting better without antibiotics,” said Le Saux, whose research appears Tuesday in the Canadian Medical Association Journal.
That’s not to say, however, that doctors should always leave antibiotics on pharmacists’ shelves when faced with a child exhibiting the symptoms of an ear infection, an often tough diagnosis to make in a squirming, crying baby or young child, she said.
Antibiotics Hearing Loss
Most middle-ear infections, formally known as otitis media, are caused by bacteria that may begin multiplying because of an underlying viral infection, causing fluid to build up inside the middle ear, which contains the eardrum. Symptoms may include fever, ear pain, reduced hearing and irritability.
While the infection usually is confined to the middle ear, there is a risk that it could spread, causing mastoiditis (infection of the mastoid bone and surrounding structures in the ear); meningitis, which can lead to severe hearing loss; or potentially fatal blood poisoning, or sepsis.
“If you’re seeing somebody with early otitis Media that’s of moderate severity, it may be reasonable to wait and see whether a child will resolve on their own,” Le Saux said Monday from Ottawa.
“But if you’re dealing with somebody who’s had symptoms of otitis for three or fours days and is becoming worse, there is evidence to treat with (antibiotics). They do make a difference.”
The December 1999-March 2002 study looked at 512 children aged six months to five years old, about half of whom were randomly prescribed amoxicillin and the other half dummy pills. Neither doctors nor parents knew which children were getting the drug and which the placebo.
The researchers checked with parents over each of the next three days to see if their child’s symptoms were improving or getting worse. If fever, irritability and pain were persisting, the child was reassessed and put on antibiotics. They were assessed again between 10 and 14 days.
Overall, 84 per cent of kids on placebo got better within 14 days, compared to almost 93 per cent of those taking amoxicillin.
“So you basically can say to parents, there’s a nine per cent difference in getting better if you get antibiotics versus no antibiotics,” Le Saux said.
But the study did find a difference between younger and older children.
For babies and toddlers six months to two years old, the study showed that 79 per cent of those on dummy pills got better within two weeks compared to 85 per cent given antibiotics. But in those aged three to five, the figures were 87 per cent versus almost 97 per cent.
Le Saux suggests the narrower gap for younger kids may mean that some had a virus – which would be unaffected by antibiotics – not a bacterial infection.
The researchers also found there was no difference in the rate of ear-infection recurrence after one-and three-month followups between the amoxicillin group and the placebo group.
“So the argument that, ‘Oh my gosh, if I don’t take antibiotics, that means my child will get recurrent ear infections.’ No,” she said. “There’s no difference in the incidence of recurrent ear infections whether you take antibiotics or not for that one particular ear infection.”
The study is likely to add fuel to the debate about years of over-prescribing of antibiotics in Canada and elsewhere around the world, which has led to a rise in drug-resistant bacterial strains.
A spokesperson for the Canadian Pediatric Society, which is reviewing its guidelines on antibiotic use, was not available for comment on the study.