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Otitis Media(Ear Infections) and Antibiotics

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Otitis Media(Ear Infections) and Antibiotics

Posted by DrDave [1744.14] on August 09, 2004 at 16:02:51:


My 1 year old had a UTI(upper respiratory tract infection) last week and was cutting two teeth on the left side at the same time. The cervical lymph nodes on the right side became very swollen and tender. About half the size of a golf ball. We took him in to our Osteopath to get another opinion. He said the said virus, wait and see. Noted a non symptomatic ear infection on the right ear, wanted to see him back in a few days just to check it because there was some bulging.

Today was is re-check visit. Not bulging anymore and a little less red........... he suggests antibiotics. Unbelievable. He knows this is why we switched to him from a pediatrician who thinks antibiotics are the answer for everything.

It's one thing to do something for which there is no research but it's another to go directly against research that has been done, over and over and over.

Here are some exerpts from the United States Agency for Health Care Policy and Research findings regarding the use of antibiotics for Otits Media(ear infections) in children.
Eight international researchers from Britain, the Netherlands and the United States reported their findings after an exhaustive search of scientific literature on the use of antibiotics for children with Otitis Media. The paper produced by the group compared the differences in results in the United States and Britain, where the use of antibiotics is prevalent, with Iceland and the Netherlands where antibiotics are used very sparingly.
According to the researchers otitis media is the, "most common reason for outpatient antimicrobial (antibiotic) use" in the U.S. They found that about 30 percent of children under the age of three receive antibiotic treatment for acute ear infections each year. This astounding number is in stark comparison to the Netherlands where antibiotic use is not even included in the initial routine treatment of otitis media.

"Does Treatment Improve Outcomes?"
"Nevertheless, since results are mixed and no study found large differences between placebo and antimicrobial groups, we conclude that the benefit of routine antimicrobial use for otitis media, judged by either short or long-term outcomes, is unproved."
"Does Treatment Prevent Complications?"
"Although preventing mastoiditis and meningitis is a rationale for antimicrobial treatment, little evidence exists that routine treatment is effective for this purpose."
"Do Children at High Risk Benefit from Antimicrobials?"
"No study has addressed whether antimicrobial treatment decreases the frequency of these (infections) in all or some of those with known risk factors."
"What is the Optimal Type and Duration of Administration?"
"In the nine country study, antimicrobials did not improve outcome at two months, and no differences in rates of recovery were found for either antimicrobial type or duration."
"No Compelling Evidence"
"After addressing these four questions, we conclude that existing research offers no compelling evidence that children with acute otitis media routinely given antimicrobials have a shorter duration of symptoms, fewer recurrences, or better long-term outcomes than those who do not receive them."
"What Is the Effect on Antimicrobial Resistance?"
"Antimicrobial use in children with otitis media results in the emergence of resistant organisms in those children and in the community. Although the organisms that cause otitis media are similar across countries, the Netherlands has a lower prevalence of resistant strains than other European countries."

RESEARCH ARTICLES

Antibiotic treatment of otitis media is no more effective than placebo, and ncreases the risks of reoccurrence.
* Cantekin EI. Antibiotics to prevent acute otitis media and to treat otitis media with effusion. JOURNAL of the AMERICAN MEDICAL ASSOCIATION 1994; 272(3):203-4 / Medline ID: 94293436

To determine the effect of antibiotic treatment for acute otitis media in children six studies of children aged 7 months to 15 years
were reviewed. 60% of placebo treated children were pain free within 24 hours of presentation, and antibiotics did not
influence this. Antibiotics seemed to have no influence on subsequent attacks of otitis media or deafness at one month.
Antibiotics were associated with a near doubling of the risk of vomiting, diarrhoea, and/or rashes. Early use of antibiotics
provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2-7 days after presentation,
17 children must be treated with antibiotics early.
* Del Mar C, Glasziou P, Hayem M, Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis., British Medical Journal 1997; 314(7093) :1526-9 /
Medline ID: 97326380

Records from 2,089 otitis media patients were examined to determine incidence and treatment success. There was no
difference in success rates between antibiotic and no antibiotic therapies.
* Tilyard MW; Dovey SM; Walker SA. Otitis media treatment in New Zealand general practice. New Zealand Medical Journal 1997; 110(1042):143-5 / Medline ID: 97296886

Patient recovery from otitis media seemed not to be influenced by either the type of antibiotic given, or the period of time for
which it was given, except that the rates of recovery were better in patient's of all age groups who did not receive any antibiotic
therapy at all.
* Froom J, Culpepper L, Grob P, et al, Diagnosis and antibiotic treatment of acute otitis media: report from international primary care network, British Medical Journal 1990; 300(6724):582-6 /
Medline ID: 90212921

Antibiotics are not the best treatment for middle ear infections (otitis media) and doctors should stop routinely prescribing drugs
for them.
* Froom J; Culpepper L; Jacobs M; DeMelker RA; Green LA; van Buchem L; Grob P; Heeren T. Antimicrobials for acute otitis media? A review from the International Primary
Care Network. British Medical Journal 1997; 315(7100): 98-102 / Medline ID: 97384382


Few issues in clinical medicine are as controversial as the efficacy and risks associated with antibiotic treatment of otitis media.
Recent studies document the emergence and rapid spread of drug-resistant streptococcus pneumoniae in acute and
unresponsive otitis as well as persistent effusions and chronic suppurative otitis. It is best to avoid the antibiotic treatment
dilemma as much as possible by not over diagnosing otitis media.
* Berman S; Management of acute and chronic otitis media in pediatric practice. Current Opinions in Pediatrics 1995; 7(5):513-22 / Medline ID: 96120875



Re: Otitis Media(Ear Infections) and Antibiotics

Posted by DrDave [1744.14] on August 09, 2004 at 16:03:47:

In Reply to: Otitis Media(Ear Infections) and Antibiotics posted by DrDave [1744.14] on August 09, 2004 at 16:02:51:

That should have read "lymph nodes on the left side".

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Re: Otitis Media(Ear Infections) and Antibiotics (Archive in ear.)

Posted by Walt Stoll [9.8] on August 10, 2004 at 06:26:45:

In Reply to: Otitis Media(Ear Infections) and Antibiotics posted by DrDave [1744.14] on August 09, 2004 at 16:02:51:

Thanks, DrDave!

There are none so blind as those who will not see!

Namaste`

Walt

Follow Ups:


Re: Otitis Media(Ear Infections) and Antibiotics

Posted by Penny [2421.11] on August 10, 2004 at 07:36:58:

In Reply to: Otitis Media(Ear Infections) and Antibiotics posted by DrDave [1744.14] on August 09, 2004 at 16:02:51:

Just wanted to mention.. all 4 of my children exibited similiar symptoms while "cutting" teeth.. the symptoms where usually most severe during the emergence of teeth in the upper rear quadrant.
EVERY time we went for our scheduled well checks at the PEDs office, during which the children were "cutting" teeth, the Doc on call would attempt to perscribe antibiotics.......... And Loving mother that I was.. LET them for the first born.... I was a bit better informed and more intuitive, by the time the rest of the children came along.

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