Postponing antibiotic usage in children with ear infections
Hat tip to MRSA Notes for this one. An study published in JAMA suggests that by telling parents to wait 48 hours to fill scripts for ear infection, physicians can help curb antibiotic overuse in children. It's not a bad idea, and it's something that I've often thought about myself. As a child I had chronic ear infections until the age of 10 when I stopped consuming dairy products. I had tubes six times. Throughout that time in my life I was averaging around one ear infection per month. In my case, waiting a day or two didn't do anything except make things worse.
Ironically, I'm sitting here now and I've got an ear infection in my left ear that I'm currently taking antibiotics for. Even more messed up is that I got the infection while on a 7 day regiment of Levaquin and Flagyl. (That's whack, eh?) Anyway, when I was a kid I wondered what people did before antibiotics. Did they go deaf? Did they walk around with chronic ear pain? Did their eardrums burst? None of my infections ever went away on their own, so I thought they stuck around until you made them go away with drugs.
Of course I know better now, and it warms the concerned medical professional and microbiology enthusiast in me to see experts pushing for moderation in antibiotic use.
Out of 238 patients aged 6 months to 12 years brought to a hospital emergency room complaining of ear infections, two-thirds of the parents who were told to wait ultimately did not fill their prescriptions.
The group that did not fill the prescriptions recovered at the same rate as children who had prescriptions filled right away, an indication the condition often clears up on its own.
Those are some impressive findings. But it doesn't get past the sense of entitlement that patients have when then visit a doctor's office. People often want antibiotics now because germs are bad, mmkay? Why else would we have all these alcohol-based antibiotic cleansers on the market that we see so heavily advertised on TV? Surely it's more than marketing…
[tags]Medicine, pharmacy, antibiotics, ear infections[/tags]
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I graduated from med school about 12 months ago, and from day 1 it was always drummed in to us that in *most* cases otitis media = no antibiotics. The key study in this decision was done in Holland, demonstrating a NNT of 17. Can fish out the details for you if you're interested…
Comment by nzdoc — October 20, 2006 @ 2:52 am
That's interesting. Here in the US, at least with docs that have been around for a while, there is no push to avoid antibiotics. I have mentioned patient entitlement a few times on this website before, and it's certainly a real phenomenon. At least here in the US, where people like to think a pill is the best solution to everything.
I'd like to read that study if you can pull it up, and it's freely available.
Comment by RJS — October 20, 2006 @ 6:01 pm
I believe the paper in question is the one below, although I don't have a copy on me at the moment:
Van Buchem FL, Peeters MF, van’t Hof MA. Acute otitis media: a new treatment strategy. BMJ 1985;290:1033-7.
There was a similar study more recently looking at younger children:
Damoiseaux RAMJ, van Balen FAM, Hoes AW, Verheij TJM, de Melker RA. Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years. BMJ 2000; 320:350-4.
(http://bmj.bmjjournals.com/cgi/content/full/320/7231/350)
While judicious use of antibiotics is advocated here, in practice the reality is often different. A sense of entitlement is prevalent here too!
Comment by nzdoc — October 20, 2006 @ 6:16 pm
FWIW, here is the Cochrane review on the topic:
http://dx.doi.org/10.1002/14651858.CD000219.pub2
Comment by nzdoc — October 20, 2006 @ 6:20 pm
Thanks for the info. I will check them out as soon as I'm done going over pain management.
The irony, of course, is that I feel an ear infection developing in my right ear as I sit here. I just got over one in my left about 2 weeks ago.
Comment by RJS — October 20, 2006 @ 6:49 pm