Antibiotics need to be used only when diagnosis of acute ear infection is certain

A new study showed that antibiotics are more effective than previously thought in the treatment of acute ear infection (namely acute otitis media) in young children. However, half of the children became better without antibiotics. Expectedly, antibiotics caused more adverse events. Antibiotics should be used only when the diagnosis of acute ear infection is certain.

Treatment failed in every fifth child (19%) receiving antibiotics and in every second child (45%) receiving placebo. These results are based on the study of a research group in Turku University Hospital, Turku, Finland. The results are today published in the prestigious medical journal The New England Journal of Medicine. The principal investigator, Dr. Aino Ruohola, M.D., Ph.D., previously received The Fellowship Award of the European Society for Paediatric Infectious Diseases.

Certain diagnosis is fundamental

• We want to emphasize that careful diagnostics is challenging, but fundamental for the management of ear infections. Symptoms cannot predict which children have ear infection. Painkillers can be given already at home if ear infection is suspected.
• It is important for the physicians to remove ear wax carefully and to use pneumatic otoscopy. During the ear examination, parents should be advised to hold their child tightly. Children with respiratory infection often have abnormal findings in otoscopic examination. Therefore, physicians need education to be able to interpret the findings.
• Antibiotics should be given only when the findings indicate a certain diagnosis of acute ear infection.

Antibiotics have side effects

All antibiotics have side effects. In this study, half of the children (48%) receiving antibiotics had loose stools or diarrhea that occurred in every fourth child (27%) receiving placebo. The most worrisome effect of antibiotics is the development of bacterial resistance which means that antibiotics are unable to kill the bacteria and are thus useless.

Within Europe, the resistance rates have wide variations between countries: the more antibiotics are used, the more problematic is the resistance situation.

Acute ear infection is the most common reason to use antibiotics in outpatient health care. Therefore, the management of this infection has strong impact on bacterial resistance. Thus, it is important to use antibiotics only when the diagnosis of acute ear infection is certain.