Quick Dips

Otic Antibiotics Over-rated

Some 97% of cases of acute ear inflammation are treated with antibiotics in New Zealand, but overseas studies now suggest that the best initial approach is adequate pain relief. In commenting on the findings, Dr Michael Baker, editor of the New Zealand Public Health Report, notes that a New Zealand study has shown "there was no significant difference between antibiotic and non-antibiotic treatment success rates".

Acute otitis media occurs when the middle ear is inflamed from infection within the eardrum, and is extremely common during childhood. A viral infection, such as a cold or measles, makes the mucus membranes vulnerable to normally harmless bacteria, and the infection spreads from the back of the nose to the ear via the Eustachian tubes. It causes violent earache, often accompanied by fever, and can lead to a perforated eardrum or other serious infection.

The overseas work looked at eight randomised controlled trials and found that 60% of children were pain-free 24 hours after presentation regardless of whether they were treated with placebo or antibiotics. Early use of antibiotics reduced the risk of pain at 2-7 days after presentation in only 6% of children with acute otitis media. This, combined with the increased vomiting, diarrhoea and rashes associated with antibiotic treatment, has led to recommendations that pain relief be the first approach, with antibiotics as an option, as well as continued observation for lack of improvement.