Observation policy appropriate for most children with middle ear infection
According to an Article in this week's issue of The Lancet, antibiotics for middle ear infection (otitis media) are only beneficial in children under the age of two with both ears infected. For most other children an observation policy seems justified finds the study.
Otitis media occurs when the middle ear, behind the eardrum, becomes inflamed. It is one of the most common childhood infections and causes pain and fever. Currently, in most countries children aged less than two years receive antibiotics when they have acute otitis media. But the latest research shows that only some of these children actually benefit from this treatment.
In the study Maroeska Rovers (University Medical Center Utrecht, Utrecht, Netherlands) and colleagues combined the data from six randomised trials assessing the effectiveness of antibiotics on otitis media, involving over 1600 children. They found that the effect of antibiotics on pain and fever was modified by age, by infection in both ears, and by the presence of otorrhoea (discharge from the ear). The results showed that for children younger than two years with otitis media in both ears, four would have to be treated with antibiotics to prevent an extended course of the disease in one child. However, in children older than two, with infection in both ears, nine children would have to be treated to prevent one extended case. For children younger than two with infection in one ear, 20 would have to be treated. The study also found that antibiotics were more beneficial in children with otorrhoea than those without irrespective of age.
The researchers believe this may be because the infection is more often bacterial than viral in children aged less than 2 years with bilateral severe otitis media and in those with otorrhoea.
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Contact: Dr Maroeska M Rovers, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 7.109, PO Box 85060, 3508 AB Utrecht, Netherlands. T) 31 30 2509399 firstname.lastname@example.org
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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