Ear drops may reduce need for antibiotics to treat ear infections

Selected use of eardrops may prevent overprescription of antibiotics for childhood ear infections while satisfying the desire of parents to treat the illness, says a new study by Brown Medical School researchers. They will present the findings April 30 at the 2001 Pediatric Academic Societies Meeting.

PROVIDENCE, R.I. — Ear infections in children don’t clear any faster with antibiotics than with pain-relieving ear drops, says a new study that suggests antibiotics may be overprescribed for the common childhood illness.

“Because ear infections resolve at similar rates, whether children receive antibiotics or drops, the study indicates that antibiotics may not be needed in many of the 20 to 25 million ear-infection cases seen in the United States annually,” said lead investigator, Paul S. Matz, M.D.

“Many parents expect an antibiotic will be prescribed for a child with an ear infection. Usually they do not come into a doctor’s office and ask for an antibiotic, but there is a physician perception that parents expect to get one. This unspoken pressure to prescribe is considered a major factor in the potential overuse of antibiotics.”

Overuse of antibiotics is cited as a significant reason for the increasing resistance worldwide among many bacterial strains, he said.

“We can tell parents that their children don’t need antibiotics all the time for ear infections,” said Matz, a research fellow in the Department of Pediatrics at the Brown Medical School. “In selected cases, use of ear drops may prevent overprescription of antibiotics, while satisfying parental desires for treatment.”

Typically, simple pain relief will make a childhood ear infection better, Matz said. In fact, standard care for ear infections, known medically as acute otitis media, includes use of pain relief medications such as acetaminophen, he said.

“At least half of ear infections will go away on their own,” Matz said. “The pain usually lasts 12 to 24 hours. Knowing that antibiotics don’t add anything, parents may wait 48 hours, while their child receives safe pain relief. If after 48 hours the child is still in pain, which happens in 5 to 10 percent of cases, then it’s appropriate to prescribe antibiotics.”

The study involved 88 children, between 2 and 18 years of age, seen in an urgent-care clinic and diagnosed with ear infections. Forty-two were randomized to receive eardrops (the compound, Auralgan™) and the other 46, an oral antibiotic.

All families completed a symptom diary, including a standardized pain scale. Children were reevaluated after 2 to 7 days, with parents asked whether they were satisfied with treatment.

Matz and colleagues found that 95 percent of children who received antibiotics got better compared to 89 percent of children who received eardrops. Treatment with Auralgan™ was as readily accepted by parents as antibiotics.

“The 89 percent of children who got better with ear drops were spared antibiotics that would have been given by the standard of care,” Matz said.

Auralgan™ is a gooey, glycerin-based compound with topical anesthetic that numbs the tympanic membrane. Antibiotics are used to kill bacteria that may reside in the infected ear.

Matz presented the findings at the 2001 Pediatric Academic Societies Meeting in Baltimore. He is based in the Division of Ambulatory Pediatrics in Rhode Island Hospital. The study’s senior author, Matz’s faculty mentor, is Anthony Alario, M.D., division director and associate professor of pediatrics. The study was funded by the Rhode Island Hospital Department of Pediatrics.

Children under age 2 were not included in the research. “There are legitimate medical concerns that these children may be more likely to experience complications from ear infections,” Matz said. “So there is less desire to withhold antibiotics from infants and toddlers.”

There is a suspected link between overuse of antibiotics to treat ear infections and the explosion of bacterial resistance, he said. In fact, there is growing resistance to the commonly prescribed amoxicillin among several bacterial strains that infect ears.

“Some bacteria that cause ear infections can also cause sepsis, pneumonia and meningitis. If they do cause one of these more serious illnesses and the bacteria has developed resistance to antibiotics, then we may have great difficulty treating that child,” Matz said.